Annual Health Bulletin C

CONTENTS

201 9 2018 Annual Health Bulletin c

Department of Health Services Central Province CONTENTS

ANNUAL HEALTH BULLETIN

2018

Department of Health Services Central Province Planning Unit 163 Sri Sangaraja Mawatha Kandy Web : www.healthcp.org E-mail : [email protected]

CONTENTS

Page Contents I List of Tables IV List of Figures XI Editorial & Review Committee XIII Map of Health care institutions XIV

1. GENERAL INFORMATION

1.1 Basic Facts 01 1.2 Administrative Divisions 01 1.3 Population 02 1.3.1 Estimated Population for 2017 and 2018 03 1.3.2 Population Density 04 1.3.3 Population distribution by sector 04 1.3.4 Age Composition 05 1.3.5 Sex Ratio 05 1.3.6 Dependency ratio 05 1.3.7 Population by Ethnicity and Religion 06 1.4 Vital Statistics 06 1.4.1 Crude Birth Rate (CBR) 07 1.4.2 Crude Death Rate (CDR) 07 1.4.3 Maternal Mortality Rate (MMR) 07 1.4.4 Under Five Child Mortality Rate ( CMR) 07 1.4.5 Infant Mortality Rate (IMR) and Neo natal Mortality Rate (NNMR) 07 1.4.6 Total Fertility Rate ( TFR) 07 1.4.7 Life Expectancy 08 1.5 Socio-Economic Indicators 08 1.5.1 Literacy Rate 08 1.5.2 Education 08 1.5.3 Computer literacy 09 1.5.4 Household Size 09 1.5.5 Access to safe drinking water 09 1.5.6 Sanitation Facilities 10 1.5.7 Electricity 10 1.5.8 Source of cooking fuel 10 1.5.9 Poverty 11 1.5.9.1 Poverty Headcount ratio 11 1.5.9.2 Household expenditure 11

2. ORGANIZATION OF HEALTH SERVICES.

2.1 Introduction 12 2.2 Provincial Health Policy 12 2.3 Provincial Health Administration 13 2.4 Health facilities in Central Province 13 2.4.1 Curative health facilities 13 2.4.2 Preventive health facilities 17 2.5 Health Manpower 18

CONTENTS

3. CURATIVE CARE SERVICES

3.1 Primary Care Services 21 3.1.1 Quality Improvement and Patient Safety assurance Project 22 3.1.2 Emergency Treatment Units 28 3.1.3 Laboratory Services 28 3.2 Secondary Care Services 30 3.2.1 Laboratory Investigations 34 3.2.2 Radiology Investigations 35 3.2.3 Electrocardiography services 37 3.2.4 Blood bank services 38 3.2.5 Physiotherapy services 38 3.2.6 Surgeries 40 3.2.7 Special clinics 40 3.2.8 Premature Baby Unit (PBU) 41 3.2.9 Intensive Care Unit (ICU) 42 3.2.10 Hospital deaths 43 3.3 Regulation of Private Health Services 43 3.4 Tertiary care services 44 3.4.1 Maternity Statistics 45 3.4.2 Laboratory Investigations 45 3.4.3 Radiology Investigations 46 3.4.4 E.C.G Services 46 3.4.5 Blood bank Services 47 3.4.6 Physiotherapy Services 47 3.4.7 Special clinics 47 3.4.8 Surgeries 48 3.4.9 Premature Baby Unit (PBU) 49 3.4.10 ICU care 50 3.4.11 Hospital Deaths 50 3.4.12 Emergency Treatment Unit 50

4. MORBIDITY AND MORTALITY

4.1 Inpatient mortality and morbidity 51

5. PREVENTIVE HEALTH SERVICES

5.1 Maternal and Child Health 56 5.1.1 Maternal Deaths 61 5.2 School Health 62 5.3 Well Woman clinic services 63 5.4 Family Planning 64 5.5 Disease Surveillance 65 5.5.1 Surveillance of Leptospirosis 66 5.5.2 Surveillance of Enteric Fever 67 5.5.3 Surveillance of Viral Hepatitis 68 5.5.4 Surveillance of Dysentery 68 5.6 Prevention and Control of Non communicable Diseases (NCD) 68 5.6.1 Chronic Kidney Disease of uncertain origin (CKDu) in the CP 71 5.9 Food and Drugs control activities 73

CONTENTS

6. SPECIAL ACHIEVEMENTS

6.1 District Base Hospital Theldeniya 76 6.2 Special Events in 2018 84

7. SPECIAL CAMPAIGNS

7.1 Malaria Control Programme 87 7.2 Surveillance of Dengue Fever/Dengue Haemorrhagic fever 95 7.3 STD, HIV/AIDS Control Programme 107 7.4 Rabies Control activities 110 7.5 Respiratory Disease Control Unit 113 7.6 Leprosy control programme 116 7.6.1 Landmark in the history of Leprosy in Sri Lanka 116

8. SPECIAL UNITS

8.1 Patient Rehabilitation Services 122 8.2 Regional Health Training Centre (RHTC) - Kadugannawa 135 8.3 Bio-Medical Engineering Services Unit 144 8.4 Oral health care services 145 8.4.1 Mobile Dental Service 147 8.5 Mental Health Services in Central Province 150

9. ESTATE HEALTH DEVELOPMENT 158

10. FINANCIAL MANAGEMENT SYSTEM 160

10.1 Recurrent Expenditure Summary 161 10.1.1 General Administration & Establishment services 161 10.1.2 Patient Care Services 162 10.1.3 Community Care Services 163 10.1.4 Summary of Recurrent Health expenditure by Programmes 164 10.2 Development Projects – Capital allocation 164 10.2.1 Provincial Specific Development Grants (PSDG) 166 10.2.2 Health Sector Development Project (HSDP) 166

11. ANNEXURES 167

III

LIST OF TABLES

1. GENERAL INFORMATION Page

Table 1.1 Administrative Divisions & Local Government Bodies 01

Table 1.2 Land area and Population by Divisional Secretarial area and sex 02

Table 1.3 Estimated population for 2017 and 2018 03

Table 1.4 Estimated population, population density and land area by Districts 04

Table 1.5 Sex Ratio by District 05

Table 1.6 Percentage Distribution of population by Ethnicity 06

Table 1.7 Percentage Distribution of population by Religion 06

Table 1.8 Live Births & Deaths Registered in 2018 07

Table 1.9 Percentages of literate population (aged 10 years and above) by sex 08

Table 1.10 Percentage distribution of population by level of education and by district 08

Table 1.11 Computer literacy of population 09

Table 1.12 Availability of drinking water by District according to percentage of 10

households

Table 1.13 Availability of sanitation facilities by District 10

Table 1.14 Types of lighting by District 10

Table 1.15 Main source of cooking fuel by District 11

Table 1.16 Poverty Headcount ratios by District 11

Table 1.17 Ratio for household food & drink and non-food items 11

2. ORGANIZATION OF HEALTH SERVICES

Table 2.1 Summary of health care institutions and field areas by District 17

(including health institutions under National ministry)

Table 2.2 Availability of wards and bed strength in institutions under 17

Central Provincial Health Department

Table 2.3 Total number of beds and beds per 1000 population in all 17

government health institutions by District in 2017 (including National ministry institutions)

LIST OF TABLES

Table 2.4 Number of private hospitals and beds by District 18

Table 2.5 The numbers of all Staff categories of health staff in Central provincial l8

health department in 2017 (as at 31st December)

Table 2.6 Cadre information of institutions under National ministry of health 20

3. CURATIVE CARE SERVICES

Table 3.1 Basic information and services delivered in primary care 23

institutions by District

Table 3.2 Services provided by primary care institutions in Central Province in 24

2017 & 2018

Table 3.3 Laboratory Services in primary care hospitals in 2017 and 2018 28

Table 3.4 Basic information and services delivered in Secondary care 30

institutions – 2018

Table 3.5 Maternal and New born Care Statistics of secondary care 33

institutions under Central Provincial Health Department and National

ministry of health in 2018

Table 3.6 Summary of Laboratory Investigations done in secondary 35

care institutions

Table 3.7 Radiological investigations done in secondary care institutions-2018 36

Table 3.8 ECG recordings done in secondary care institutions-2018 37

Table 3.9 Blood bank statistics of secondary care institutions-2018 38

Table 3.10 Physiotherapy services at secondary care institutions-2018 39

Table 3.11 Surgeries conducted in secondary care institutions-2018 40

Table 3.12 Specialized clinics conducted in secondary care institutions-2018 40

Table 3.13 Premature Baby Care in secondary care institutions-2018 41

Table 3.14 ICU statistics in secondary care institutions-2018 42

Table 3.15 Hospital deaths occurred in secondary care institutions-2018 43

Table 3.16 The bed strength and the services provided by tertiary care institutions in Central Province-2018 44 V

LIST OF TABLES

Table 3.17 Maternity Statistics-2018 44

Table 3.18 Laboratory Investigations-2018 45

Table 3.19 Radiology Investigations-2018 46

Table 3.20 E.C.G. services-2018 46

Table 3.21 Blood bank services-2018 47

Table 3.22 Physiotherapy services-2018 47

Table 3.23 Special clinics held-2018 47

Table 3.24 Surgeries-2018 48

Table 3.25 Premature Baby Unit (PBU) -2018 49

Table 3.26 ICU statistics-2018 50

Table 3.27 Hospital deaths-2018 50

Table 3.28 Emergency Treatment Unit-2018 50

4 MORBIDITY AND MORTALITY

Table 4.1 Leading causes of hospitalization in Central Province-2017 52

Table 4.2 Leading causes of hospital deaths in Central Province-2017 57

5. PREVENTIVE HEALTH

Table 5.1 The population statistics and types of clinics during 2017 and 2018 56

Table 5.2 Ante natal Care Services provided in the Central Province-2017-2018 57

Table 5.3 Results of natal Care provided in the Central Province-2017-2018 58

Table 5.4 Post partum care provided by the Public health midwives-2017-2018 58

Table 5.5 Post partum maternal morbidities reported in the Central Province 59

Table 5.6 Infant care provided by Public Health Midwives-2017-2018 59

Table 5.7 Growth Monitoring of Children under 5 years 60

by Public Heath Midwives

Table 5.8 Distribution of causes of maternal deaths in Central Province-2017 60

Table 5.09 School Health Activities in the Central Province-2017-2018 63

LIST OF TABLES

Table 5.10 Performance in Well Women Clinics 64

in the Central Province-2017-2018

Table 5.11 Family Planning new acceptors 20017-2018 64

Table 5.12 Number of Cases Notified during 2017 -2018 65

Table 5.13 Leptospirosis cases in the Central Province from 2008-2018 66

Table 5.14 Enteric Fever cases in the Central Province from 2017-2018 67

Table 5.15 Vital Hepatitis cases in the Central Province from 2017-2018 68

Table 5.16 Dysentery cases in the Central Province from 2008-2018 68

Table 5.17 NCD Activities in 2017 & 2018 70

Table 5.18 CKD/CKDu Screening Programme Matale District 2018 72

Table. 5.19 Activities on Cosmetics and Drugs-2017-2018 73

7 SPECIAL CAMPAIGNS

Table 7.1 Number of malaria cases reported by districts from 2001-2018 88

Table 7.2 Number of blood films, malaria cases and annual parasite incidence 89

(API ) by district-2017-2018

Table 7.3 Entomological surveillance of Malaria by districts-2017-2018 90

Table 7.4 Indoor residual insecticide spraying-2017-2018 91

Table 7.5 Distribution of long lasting insecticide treated bed nets-2017-2018 91

Table 7.6 Application of larvivorous fish, P.reticulata by district-2017-2018 92

Table 7.7 Health education and community awareness programmes 92

conducted inKandy and Nuwara eliya districts-2017-2018

Table 7.8 Health education and community awareness programmes 94

conducted in Matale district-2017-2018

Table 7.9 Number and percentage of houses positive for Ae. aegypti/ Ae. 98

albopictus in different MOH areas in the Kandy and Nuwara Eliya districts-2017-2018

Table 7.10 Number of actual breeding sites of Ae. aegypti and Ae. albopictus in 99

VII

LIST OF TABLES

different MOH areas in the Kandy and Nuwara Eliya districts

Table 7.11 Number and percentage of potential breeding sites per 100 houses in 100

the Kandy and Nuwara Eliya districts-2017-2018

Table 7.12 CI, HI and BI in different MOH areas in the Kandy and Nuwara Eliya 101

districts-2017 – 2018

Table 7.13 No of houses positive for Ae.aegypti and Ae.albopictus and No of 102

containers positive for Ae.aegypti and Ae.albopictus in Matale district

Table 7.14 Dengue vector surveillance - Other Premises -2017-2018 103

Table 7.15 Percentage of different containers types positive for Ae.aegypti 104

Ae.albopictus in Matale District-2017-2018

Table 7.16 Application of larvivorous fish in water storage containers by MOH 105

areas 2016 & 2017 in Matale district

Table 7.17 Number of Rounds of space spraying in MOH areas-2017-2018 106

Table 7.18 Clinic attendance and no. of newly diagnosed 107

cases by District in Central Province 2017 and 2018

Table 7.19 Serology test for Syphilis in Kandy District-2017-2018 107

Table 7.20 Serology test for Syphilis in Matale District-2017-2018 108

Table 7.21 Serology test for Syphilis in Nuwara eliya district-2017-2018 108

Table 7.22 Serology test for HIV in Matale District-2017-2018 109

Table 7.23 Serology test for HIV in Kandy District-2017-2018 109

Table 7.24 Serology test for HIV in Nuwaraeliya District-2017-2017 8 109

Table 7.25 Human Rabies Deaths 2018 111

Table 7.26 Post Exposure prophylaxis used in the Central Province 2008-2018 111

Table 7.27 The usage of Human ARV & ARS by Hospital in the Central Province 111

Table 7.28 Incidence of Tuberculosis cases by type in Nuwaraeliya District 2017 113

& 2018

Table 7.29 Incidence of Tuberculosis cases by type in Kandy District 2017 & 2018 113

Table 7.30 Incidence of Tuberculosis cases by type in Matale District 2017 & 2018114

VIII

LIST OF TABLES

Table 7.31 Percentage Distribution of new smear positive cases 114

by sex 2017 & 2018

Table 7.32 Distribution of TB cases by District-2017-2018 114

Table 7.33 Clinic Attendance of TB-2017-2018 115

Table 7.34 No of Investigations Carried out and Results-2017-2018 115

Table 7.35 Treatment success in 2017 & 2018 115

Table 7.36 Incidence of leprosy by District in the CP from 2011 – 2018 120

Table 7.37 Proportion Child patients and Deformities reported in 2017 & 2018 120

Table 7.38 Treatment and rehabilitation status-2017-2018 121

8. SPECIAL UNITS

Table 8.1 Summary of basic information and services delivered at Physical 132

Rehabilitation Center Digana-2013-2018

Table 8.2 Details of Clinics held in 2018 133

Table 8.3 Physiotherapy, Occupational therapy & Speech therapy 133

statistics-2018

Table 8.4 Contribution of well-wishers-2018 134

Table 8.5 Programmes conducted in 2018 at RHTC Kadugannawa 141

Table 8.6 Basic training programmes conducted in 2017/2018 at RHTC 143

Table 8.7 Selected performance indicators in MCH in the MOH area-2013-2018 143

Table 8.8 Dental services in Central Province in 2018 147

Table 8.09 Performance of Dental Surgeons in 2018 148

Table 8.10 Performance of School Dental Therapists in 2018 149

Table 8.11 Mobile Dental Unit Performances 2018 149

Table 8.12 Mental Health Staff Kandy-Matale-Nuwaraeliya Districts 152

Table 8.13 Diagnosed new cases by type of disease in 2018 156

Table 8.13 Human Resource Development in 2018 157

LIST OF TABLES

9 ESTATE HEALTH DEVELOPMENT

Table 9.1 Statistics of Estate population in the CP 158

Table 9.2 List of Estate hospitals taken over to State Health system 159

10. FINANCIAL MANAGEMENT SYSTEM

Table 10.1 Total Financial allocation to the CP in 2017 and 2018 160

Table 10.2 General administration-2018 161

Table 10.3 Patient Care Services-2018 162

Table 10.4 Preventive Care Services-2018 163

LIST OF FIGURES

1. GENERAL INFORMATION

Fig.1.1 Population distribution by sector 04

Fig.1.2 Age- sex distribution of population in Central Province 05

2. ORGANIZATION OF HEALTH SERVICES

Fig. 2.1 Provincial Health Organization Structure 15

Fig. 2.2 Regional Health Organization Structure 16

3. CURATIVE CARE SERVICES

Fig.3.1 OPD Attendance in Primary Care Hospitals 25

Fig.3.2 Indoor Admissions in Primary Care Hospitals 25

Fig.3.3 Bed Occupancy Rate in Primary Care Hospitals 26

Fig.3.4 Clinic Attendance in Primary Care Hospitals 26

Fig.3.5 Number of Deliveries in Primary Care Hospitls 27

Fig.3.6 No. of Patients treated in ETU 27

Fig.3.7 Indoor Admissions in Secondary Care Hospitals 31

Fig.3.8 Total No. of Deliveries in Secondary Care Hospitals 32

Fig.3.9 Clinic Attendance in Secondary Care Hospitals 32

Fig.3.10 No.of patients treated at ETUs in Secondary Care Hospitals 33

Fig.3.11 Laboratory Investigations in Secondary Care Hospitals 35

Fig.3.12 Radiology Investigations in Secondary Care Hospitals 37

Fig.3.13 ECG Investigations in Secondary Care Hospitals 38

Fig.3.14 Physiotherapy services provided in Secondary Care Hospitals 39

5. PREVENTIVE HEALTH SERVICES

Fig. 5.1 Trends of Maternal Mortality Ratio by District 62

of Central Province -2001-2018

Fig. 5.2 No of reported Cases of Leptospirosis from 2008-2018 in the CP 67 XI

LIST OF FIGURES

7. SPECIAL CAMPAIGN

Fig. 7.1 Reported Dengue cases in Kandy District during 2014-2018 96

Fig. 7.2 Reported Dengue cases in Matale District during 2014-2018 97

Fig. 7.3 Reported Dengue cases in Nuwaraeliya District during 2014-2018 97

Fig. 7.4 Percentage of container type among the breeding places in 2018 104

Fig. 7.5 Percentage of container type among the breeding places in 2018 105

10. FINANCIAL MANAGEMENT SYSTEM

Fig. 10.1 Total allocation (both capital and recurrent) 160

for the Province 2007-2018

Fig. 10.2 Total Expenditure (both capital and recurrent) 164

during year 2007-2018

XII

EDITORIAL AND REVIEW COMMITTEE

Dr. Arjuna Thilakarathne Provincial Director of Health Services

Dr. S.W.M.K.K. Singhaprathapa Deputy Provincial Director of Health Services

Dr. Damitha Gunawardane Consultant Community Physician (Planning)

Dr. Ajith Weerakoon Consultant Community Physician (MCH)

Dr. Suranga Fernando Community Physician (Epidemiology)

Dr. P.T.S. Prasanga Medical Officer (Planning)

Dr. P.U.H.D.K. Wijayathilake Registrar in Community Medicine

Dr. P.G.K. De Silva Registrar in Community Medicine

Mrs. A. Rajika Priyanthi Chief Accountant

Mr. G.S. Nanayakkara Planning & Programming Assistant

XIII

Map of Health Care Institutions

XIV

ANNUAL HEALTH BULLETIN – 2018 General information

1. GENERAL INFORMATION

1.1 Basic Facts Central Province is located in the central hills of Sri Lanka and consists of the three Districts Kandy, Matale and Nuwara Eliya. The land area of the Province is 5674 square kilometers which is 8.6% of the total land area of Sri Lanka. The Province lies on 6.6°- 7.7° Northern latitude and between 80.5°-80.9° Eastern longitudes. The elevation in the province ranges from 182.8 meters to over 1828.8 meters above sea level in the central hills. The Province is bordered by the North Central Province from the North the Mahaweli River and Uma Oya from the east to the south from the mountain range of Adams peak, Kirigalpottha and Thotupala and the mountain ranges Dolosbage and Galagedera from the west. The mean temperature ranges from 16°C - 28°C in the Province where lower temperatures are recorded in hills in the Nuwara Eliya District. Temperature decreases at a steady rate of about 6.50 C for each 1,000 meter rise. Thus, at Kandy, which is 488 meters above mean sea level, the mean annual temperature is about 24.50 C and Nuwara-Eliya, where the elevation is 1895 meters, the mean annual temperature is about 15.80 C. The Province is divided into three zones namely wet, dry and intermediate according to the rain fall. The south west monsoon provides most of the rainfall to the central hills where Watawala records the highest rainfall of 5024 mm annually while 80% of the Matale District shows a rainfall pattern of the dry zone gets its rainfall from the North east monsoon. The rainfall in Dambulla is reported as 1234 mm.

In the Central Province 52% of the land has been cultivated while another 6.3% has been identified as lands which can be cultivated. Of the lands cultivated more than 35% has been cultivated with tea while 14.8% has been cultivated with paddy. The percentage of lands cultivated with coconut and rubber is 4.8% and 2.3% respectively.

1.2 Administrative Divisions

For the purpose of administration the Central Province has 36 Divisional Secretary areas in the 3 Districts. The number of GN areas, villages and local government bodies under each District is given in table 1.1

Table 1.1 Administrative Divisions & Local Government Bodies

Local Administrative Divisional Grama Pradeshiya Government Areas Secretary Niladari Villages Saba Bodies ( District ) Areas Divisions MC UC Sri Lanka 331 14,021 271 36,822 23 41 Kandy 20 1,187 17 2,833 1 4 Matale 11 545 11 1,344 2 0 Nuwara Eliya 05 491 05 1,199 1 2 Central 36 2,223 33 5,376 4 6 Province Source: Department of Census & Statistics 1

ANNUAL HEALTH BULLETIN – 2018 General information

1.3 Population

According to the census data 2012 the total population of Central Province was 2,571,557. The average annual growth rate 2013 was 1.1% for Sri Lanka and the rate for Kandy, Matale and Nuwaraeliya were 0.65%, 0.88% and 0.05% respectively. (Department of Census). The annual growth rate for Sri lanka in 2017 was 1.1%.

Table 1.2 Land area and Population by D.S. Division and sex

Land area Population Divisional Secretary Division km2 Total Male Female

Kandy District Thumpane 54 37,642 18,215 19,427 Poojapitiya 59 57,914 27,327 30,587 Akurana 31 63,397 29,940 33,457

Pathadumbara 51 88,725 41,920 46,805

Panvila 93 26,294 12,213 14,081

Udadumbara 277 22,505 11,040 11,465 Minipe 250 51,883 25,468 26,415 Medadumbara 196 61,034 28,852 32,182

Kundasale 81 127,070 60,589 66,481

Kandy Four Gravets & 59 158,561 76,284 82,277 Gangawata Korale

Harispattuwa 49 88,177 41,267 46,410

Hatharaliyadda 62 29,986 14,242 15,744

Yatinuwara 72 106,027 50,921 55,106

Udunuwara 68 110,905 53,554 57,351

Doluwa 95 49,842 24,407 25,435

Pathahewaheta 84 58,188 28,030 30,158

Delthota 49 30,345 14,179 16,166

Udapalatha 94 91,716 42,716 49,000

Gangaihala Korale 94 55,254 26,539 28,715

Pasbage Korale 122 59,917 27,588 32,329

Total 1,940 1,375,382 655,791 719,591

ANNUAL HEALTH BULLETIN – 2018 General information

Matale District Galewela 187 70,042 33,619 36,423 Dambulla 444 72,306 36,307 35,999 Naula 276 30,884 15,088 15,796 Pallepola 81 29,565 14,022 15,543 Yatawatta 63 30,242 14,496 15,746 Matale 70 74,864 35,550 39,314 Ambanganga Korale 55 15,643 7,324 8,319 Laggala-Pallegama 385 12,110 6,217 5,893 Wilgamuwa 256 29,494 14,682 14,812 Rattota 99 51,354 24,239 27,115 Ukuwela 77 68,027 32,113 35,914 Total 1,993 484,531 233,657 250,874 Nuwara Eliya District Ambagamuwa 489 205,723 97,448 108,275 Hanguranketha 229 88,528 42,156 46,372 Kothmale 225 101,180 48,527 52,653 Nuwara Eliya 478 212,094 102,338 109,756 Walapane 320 104,119 49,878 54,241 Total 1,741 711,644 340,347 371,297 Source: Department of Census & Statistics 2012

The Provincial administration is vested in the Central Provincial Council composed of elected representatives of the people, headed by a Governor who is appointed by His Excellency the President.

1.3.1 Estimated Population for 2017 and 2018

The estimated mid-year population is calculated based on final results of the Census of Population.

Table 1.3 Estimated population for 2017 and 2018

2017 2018 Total Male Female Total Male Female Sri Lanka 21,444,000 10,382,000 11,062,000 21,670,000 10,492,000 11,178,000

Kandy 1,452,000 692,000 760,000 1,468,000 700,000 768,000 Matale 514,000 248,000 266,000 519,000 250,000 269,000 Nuwara Eliya 756,000 362,000 394,000 763,000 365,000 398,000 Central 2,722,000 1,302,000 1,420,000 2,750,000 1,315,000 1,435,000 Province Source: Department of Census & Statistics

ANNUAL HEALTH BULLETIN – 2018 General information

1.3.2 Population Density

The population density for the Central Province was 483 persons per square kilometer. The density was higher than the estimated national average in the Districts of Kandy and Nuwara Eliya while in the Matale District the population density was lower than the national figure. (Table 1.4)

Table 1.4 Estimated population, population density and land area by Districts

Kandy Matale Nuwara Central Sri Lanka Eliya province

Estimated population 1,468,000 519,000 763,000 2,750,000 21,670,000 (2018)

Population density (estimated) 765 262 447 493 345 (persons per square km)

Land area/km2 1,917 1,977 1,706 5,575 62,705

2 Inland waters/km 23 41 35 99 2,905

2 Total land area/ km 1,940 1,993 1,741 5,674 65,610

Source: Department of Census & Statistics & Survey Department

1.3.3 Population distribution by sector

The total population in Sri Lanka is 20,359,439 million in 2012. According to the census data, 77.4%, 18.2% and 4.4% of the population were classified as rural, urban and estate respectively in Sri Lanka. Fig. 1.1 Population distribution by sector in Central Province

Series1, Series1, Estate, Urban, 18.9, 19% 10.5, 10% Urba

Rura l

Series1,

Rural, 70.6, 71% Source: Department of Census & Statistics 2012

ANNUAL HEALTH BULLETIN – 2018 General information

1.3.3 Age composition

The age-sex distribution of population is given in figure 1.2.

Fig 1.2 Age- sex distribution of population in Central Province

Source: Department of Census & Statistics 2012

1.3.4 Sex ratio Sex ratio is defined as the number of males per 100 females. Census 2015 reports that there are 94 males for every 100 females in Sri Lanka. According to the data Matale district sex ratio (93) is higher than those ratios in Kandy district (91) and Nuwara Eliya district (92). The districts in the Central Province have significantly lower sex ratio than the national ratio. Table 1.5 Sex Ratio by District

District Sex ratio Kandy 91 Matale 93 Nuwara Eliya 92 Source: Registrar General’s Department 2015

1.3.5 Dependency ratio

This simply explains how many people in the working age group to support dependents in the population. Over all dependency ratio of the country in 2012 was 60.2 percent. Child (under 15 years) dependency shows how many people in the working age group (15-59 years) to support children in the population. Child dependency ratio was 40.4 percent. Old age dependency shows how many people in the working age group to support people in the old age group (60 years or more) people in the population. The old age dependency ratio was 19.8 percent.

ANNUAL HEALTH BULLETIN – 2018 General information

1.3.6 Population by ethnicity and religion

The 2012 census data shows that 66% of the total population living in the Central Province was Sinhalese, while 23.8% were Tamils and 9.9% were Muslims. The detailed breakdown by District is given in table 1.6. The distribution of the population in the Central Province according to religion shows that 65.0% were Buddhist, while 21.0%, 10.3% and 2.5% were Hindu, Islam and Roman Catholic respectively.

Table 1.6 Percentage Distribution of population by Ethnic group

Kandy Matale Nuwara Central Sri Lanka Eliya Province Sinhalese 74.4 80.8 39.6 66.0 74.9

Tamil 11.2 9.8 57.6 23.8 15.3

Sri Lanka Moor 13.9 9.2 2.5 9.9 9.3 Others 0.4 0.2 0.2 0.3 0.5 Source: Department of Census & Statistics 2012

Table 1.7 Percentage Distribution of population by Religion

Kandy Matale Nuwara Central Sri Lanka Eliya Province 73.4 79.5 39.1 65.0 70.1 Buddhist

9.7 9.0 51.0 21.0 12.6 Hindu 14.3 9.4 3.0 10.3 9.7 Islam Roman Catholic 1.6 1.6 4.7 2.5 6.2

Others 1.0 0.5 2.2 1.2 1.4

Source: Department of Census & Statistics 2012

1.4 Vital Statistics

Registration of births and deaths was made compulsory in 1867 with the enactment of the civil registration laws which conferred the legal sanction for the registration of events namely live births, deaths, still births and marriages. The compilation of vital statistics has a well organized system for the flow of necessary information from registration officers to the statistical branch where compilation of vital statistics is taken place.

1.4.1 Crude Birth Rate (CBR)

The CBR is based on the usual residence for Sri Lanka was reported as 15.1 per 1000 population in 2018. The CBR for Kandy, Matale, Nuwara Eliya and Central Province was 15.7, 14.9, 14.1 and 15.1 per 1000 population respectively in 2018. (Registrar General‟s Department)

ANNUAL HEALTH BULLETIN – 2018 General information

1.4.2 Crude Death Rate (CDR)

The CDR is based on the usual residence for Sri Lanka was 6.4 per 1000 population in 2018. In 2018, the CDR for Kandy, Matale, Nuwara Eliya and Central Province was 7.0, 6.6, 6.2 and 6.7 per 1000 population respectively. (Registrar General‟s Department)

Table.1.8 Live Births & Deaths Registered in 2018 No of Live No of Deaths Births Kandy 26,095 11,335 Matale 8,164 3,234 Nuwara Eliya 7,779 3,993 Central Province 42,038 18,562 Sri Lanka 328,112 139,498 Source: Registrar General’s Department

1.4.3 Maternal Mortality Ratio (MMR)

Maternal deaths are reported to three different reporting agencies namely Registrar General‟s Department, Hospital statistics and Maternal Mortality active surveillance system coordinated by the Family Health Bureau of the Ministry of Healthcare and Nutrition. The national MMR released by the Family Health Bureau for the year 2017 was 39.3 per 100,000 live births. The MMR for Kandy, Matale, Nuwara Eliya and CP in 2017 was 42.1, 62.1, 46.7 and 46.8 per 100,000 live births respectively. 1.4.4 Under Five Child Mortality Rate (CMR)

The Child Mortality Rate reported by the Family Health Bureau for Kandy, Matale, Nuwaraeliya districts and CP for the year 2018 is 11.5, 10.1, 15.7 and 12.0 per 1000 live births respectively while this value for Sri Lanka is 10.6 per 1000 live births.

1.4.5 Infant Mortality Rate (IMR) and Neo natal Mortality Rate (NNMR)

The IMR and NNMR (first 28 days after birth) has declined over the last few decades and the Sri Lankan figure of IMR reported by Family Health Bureau for the year 2018 is 9.1 per 1000 live births. The IMR in Kandy, Matale, Nuwaraeliya districts and CP for the year 2018 is 10.2, 9.8, 12.9 and 10.6 per 1000 live births respectively. The Neonatal Mortality Rate for Sri Lanka is 6.5 per 1000 live births for the year 2018 and the figure in Kandy, Matale, Nuwaraeliya districts and CP for the year 2018 is 7.4, 6.6, 9.2 and 7.6 per 1000 live births respectively.

1.4.6 Total Fertility Rate (TFR)

Fertility rate; total (births per woman) in Sri Lanka was last measured at 2.2 in 2016. TFR in Kandy, Matale and Nuwaraeliya is 2.6, 1.9 and 2.2 respectively in year 2016. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with current age-specific fertility rates. (DHS 2016- Department of Census)

ANNUAL HEALTH BULLETIN – 2018 General information

1.4.7 Life Expectancy

The life expectancy at birth is 75.3 years in 2016. The rapid increase in the average life span together with widening gap between males and females longevity is due to the reduction of infant and child mortality and also the reduction of mortality of women of the child bearing age.

1.5 Socio - Economic Indicators

1.5.1 Literacy Rate

Literacy rate is a key indicator to measure the level of reading and writing ability of persons in a country. The definition of literate person is given as “If a person can both read and write a short statement with understanding is considered as literate”. According to the results shown in the Table 1.9 literacy rate of the population aged 10 years and above in Central province stands at 93.9 percent. The corresponding rate for males and females are 96.1 percent and 92.0 percent respectively. (Source - Department of Census).

Table 1.9 Percentages of literate population (aged 10 years and above) by sex

Both Male Female Kandy 95.4 96.8 94.2 Matale 94.2 95.7 92.8 Nuwara Eliya 90.9 94.9 87.2 Central Province 93.9 96.1 92.0 Sri Lanka 95.7 96.9 94.6

1.5.2 Education

According to the data, 3.8 % of the population in Sri Lanka had not been to school and the figure for Nuwaraeliya was twice than the national figure.

Table 1.10 Percentage distribution of population by level of education and by district

Kandy Matale Nuwaraeliya Sri Lanka

No Schooling 4.2 4.5 7.6 3.8 Passed primary 22.5 26.0 33.9 23.6 Passed secondary 38.5 43.1 38.1 40.6 Passed G.C.E.(O/L) 17.4 14.4 12.7 17.0 Passed G.C.E.(A/L) & 14.3 10.2 6.6 12.3 above Degree or above 3.2 1.9 1.1 2.7

Source: Department of Census 2012

ANNUAL HEALTH BULLETIN – 2018 General information

1.5.3 Computer literacy

A person is considered as a computer literate if he could use computer on his own. For example, even if a 5 year old child can play a computer game then he is considered as a computer literate person.

If a person has heard of any of the wide range of applications computers are used for, (e.g. any use ranging from playing computer games to complicated aeronautic applications) then he is considered as a person in computer awareness.

Table 1.11 Computer literacy of population in 2016

Computer literacy rate % Kandy 31.2 Matale 30.0 Nuwaraeliya 14.7 Central Province 26.3 Sri Lanka 27.6 Source : Department of Census & Statistics

1.5.4 Household Size

The National average for household size is 3.8 persons per household while this figure for Kandy, Matale and Nuwara Eliya is 3.8, 3.6 and 3.9 persons per household respectively. (DHS 2016- Department of Census)

1.5.5 Access to safe drinking water 31.4% of households in Sri Lanka use pipe born water while in Kandy this figure was 50.3%, in Matale, 29% and in Nuwara Eliya it was about 29.6 %.

Table 1.12 Availability of drinking water by District according to percentage of households Water source Kandy Matale Nuwaraeliya Sri Lanka Protected well within premises 14.3 20.6 5.0 31.4 Protected well outside premises 11.1 17.6 5.6 14.7 Tube well 1.9 5.8 0.6 3.4 Piped born water 50.3 29.0 29.6 31.4 Rural water supply project 11.3 17.3 21.1 9.2 Unprotected well 2.9 4.0 3.8 4.0 Other (bowser, Bottled water, 8.2 5.7 34.2 5.9 River/Tank/Stream/Spring) Source: Department of Census & Statistics 2012

ANNUAL HEALTH BULLETIN – 2018 General information

1.5.6 Sanitation Facilities

3.9% of the households of Nuwaraeliya district do not have any type of facility for safe sanitation and this value is 2 times higher than the national value which is 1.7%.

Table 1.13 Availability of sanitation facilities by District

Type of Kandy Matale Nuwaraeliya Sri Lanka Toilet Exclusive 89.9 87.0 80.0 86.7 Shared 9.1 12.3 15.0 10.9

Common 0.5 0.2 1.1 0.7 Not using a 0.5 0.5 3.9 1.7 toilet Source: Department of Census & Statistics 2012

1.5.7 Electricity

87.0% Households in Sri Lanka have electricity while this figure for Kandy, Matale and Nuwara Eliya are 92.4%, 84.0% and 88.0% respectively. Table 1.14 Types of lighting by District Nuwara Type of lighting Kandy Matale Sri Lanka eliya Electricity ‐ from National Grid 92.4 84.0 88.0 87.0 Electricity ‐ from rural hydro power project 0.2 0.4 - 0.2 Kerosene 7.2 14.8 11.8 12.2 Solar power 0.1 0.9 0.2 0.6 Bio gas 0.0 0.0 0.0 0.0 Other 0.0 0.0 0.1 0.1

Source: Department of Census & Statistics 2012

1.5.8 Source of cooking fuel

More than 80% of the households in all 3 districts use firewood as the main source of cooking.

Table 1.15 Main source of cooking fuel by District Nuwara Type of cooking fuel Kandy Matale Sri Lanka eliya Firewood 80.8 90.9 86.5 78.4 Kerosene 1.1 0.5 1.9 2.5 Gas 17.8 8.4 11.2 18.5 Electricity 0.2 0.1 0.3 0.2 Saw dust/paddy husk 0.0 0.0 0.1 0.1 Other 0.1 0.1 0.1 0.3

ANNUAL HEALTH BULLETIN – 2018 General information

1.5.9 Poverty

1.5.9.1 Poverty Headcount ratio

Percentage of population below the poverty line is defined as the Poverty Headcount ratio. According to the Household Income and Expenditure Survey (2012/13) done by Department of Census and Statistics, Poverty Headcount ratio for Sri Lanka was 6.7% and the values for Kandy, Matale and Nuwaraeliya districts were 6.2%, 7.8% and 6.6% respectively.

Table 1.16 Poverty Headcount ratio by District

2016 Kandy 5.5 Matale 3.9 Nuwaraeliya 6.3 Sri Lanka 4.1

1.5.9.2 Household expenditure

Table 1.17 Ratio for household food & drink and non-food items by province and district - 2016

Nuwara Central Kandy Matale Sri Lanka Eliya Province

Ratio for Food & drink 33.9 36.4 42.8 36.4 34.8 Ratio for Non-food

66.1 63.6 57.2 63.6 65.2

Source: Household Income and Expenditure Survey - 2016 - Department of Census and Statistics

ANNUAL HEALTH BULLETIN – 2018 Organization of Health Services

2. ORGANIZATION OF HEALTH SERVICES

2.1 Introduction

Both public and private sectors provide health care to the people in Central Province. However, public sector plays the major role in providing health care for the people in the Province. The private sector and estates organizations also provide health care to a lesser extent. The Department of Health Services of Central Government and Provincial Government cover the entire range of promotive, preventive, curative and rehabilitative health care services in the Province.

The private sector provides mainly the curative care through outpatient services. This includes few private hospitals with indoor facilities, full-time general practitioners, government doctors who are engaged in part-time private practice out side their duty hours and other private facilities like laboratories and pharmacies. Recently, few of non- government organizations came forward to assist the government to strengthen preventive care services. Nearly 98% of inpatient care is provided by the government health care institutions in the province.

Western (allopathic), Ayurvedic, Unani, Siddha, and Homeopathy systems of medicine are practiced in Central Province. Of these, Western (allopathic) medicine is the main sector catering for the need of the vast majority of the people. In the Central Province, the Department of Health Services is mainly concerned about western medicine. The Department of Ayurveda also provides health care for a significant number of people in the Province.

Central Province is equipped with an extensive network of health care institutions. Primary and secondary health care institutions in the curative sector as well as preventive and rehabilitative care institutions are mainly managed by the Provincial Health Department and tertiary care health institutions are managed by the line ministry.

2.2 Provincial Health Policy

Vision: - To be the excellent Provincial Department of Health services in Sri Lanka.

Mission: - . Developing Human Resources in the whole department with knowledge skill and attitudes. . Improving essential infrastructure for all health services. . Providing modern technology for all service centers. . Strengthening a positive relationship with other government department as well as the other parties who are involved in catering health services. . Motivation the staff in order to achieve above goals.

Goal: -  To protect and promote the health of people in the central province.

ANNUAL HEALTH BULLETIN – 2018 Organization of Health Services

Specific Goal: -  To create a community which is committed to the prevention of diseases.  To create a healthy and satisfied community through providing qualitative and proportionately adequate curative care services.  Upliftment of areas which require special attention in the health sector such as Estate Health Sector, Rehabilitation of physically and mentally disadvantaged patients, Healthy and safe work place.  To develop the quality of the service through a systematically planned human resource development.  To instill the concept of “ customer friendly “ health services through the development of the attitudes among all health staff.

2.3 Provincial Health Administration

Previously, the entire health system of Sri Lanka functioned under a Cabinet minister of the Central Government. However, with the implementation of Provincial Council Act in 1989, the health services were devolved, resulting in the Ministry of Health at the national level and separate Ministries of Health in the nine Provinces.

The Central Ministry of Health plays a major role in development of national health policies and guidelines, training of medical and Para- medical staff, management of teaching hospitals and specialized medical institutions and bulk purchase of medical requisites. The Provincial Health Department is totally responsible for management and effective implementation of health services within the Province, development of policies and guidelines for the Province and also human resource management within the Province.

In the Central Province, the Department of Provincial Health Services is under the Ministry of Health, Indigenous Medicine, Social Welfare, Probation & Child care Services. There is a Minister and a Secretary to the Ministry.

The Provincial Director is the head of the Provincial Department of Health Services. There are 3 Regional Directors of Health Services (RDHS) for each District. Each RDHS area is geographically similar to the administrative units of District Secretariats. The Medical officers of Health (MOH) are mainly responsible for the preventive care of the respective Divisional Secretary areas and the medical officers in charge of the hospitals are responsible for provision of curative care through their institutions.

2.4. Health facilities in Central Province

2.4.1 Curative health facilities

The network of curative care institutions ranges from sophisticated Teaching Hospitals with specialized consultative services to small Primary Medical Care Units, which provide only out patient services. The distinction between hospitals is basically made on the size and the range of facilities. There are three levels of curative care institutions.

(a) Primary Care Institutions

 Divisional Hospitals (DH)

ANNUAL HEALTH BULLETIN – 2018 Organization of Health Services

 Primary Medical Care Units (PMCU)

(b) Secondary Care Institutions

 District General Hospitals (DGH)  District Base Hospitals (DBH)

(b) Tertiary Care Institutions

 Teaching Hospitals (TH)  Provincial Hospitals (PH)

ANNUAL HEALTH BULLETIN – 2018 Organization of Health Services

Accountant Chief

ANNUAL HEALTH BULLETIN – 2018 Organization of Health Services

logy logy

unit Regional Regional epidemio

Accountant

ANNUAL HEALTH BULLETIN – 2018 Organization of Health Services

2.4.2 Preventive health facilities Preventive care is provided through a well organized system of MOH offices as described earlier. Summary of health care institutions and field areas in the three Districts in the Province is given in table 2.1. The details of this table and the names of the curative care institutions are given in annexure 1-4.

Table 2.1 Summary of health care institutions and field areas by District (including health institutions under line ministry)

DBH

PHM

MOH

areas

PMCU

areas*

d units d

DGH and DGH

PHI areas PHI

Administr

Specialize ativeunits Kandy 23 72 454 03 03 47 28 13 02 Matale 13 36 157 - 02 18 15 05 01 Nuwaraeliya 13 39 316 - 03 24 21 03 01 Central 49 147 927 03 08 89 64 21 04 province

* Kandy, Matale, Dambulla & Nuwaraeliya Municipal MOH area are also included. Teaching hospitals Kandy, Peradeniya and Sirimawo Bandaranaike Memorial Children‟s hospital, DGH Nuwaraeliya and DBH Gampola come under line ministry.

Table 2.2 Availability of wards and bed strengths in institutions (DGH, DBH, DH) under Central Provincial Health Department

No. of No of No of wards institutions beds Secondary care Kandy 02 25 647 institutions Matale 02 34 114 Nuwaraeliya 02 18 334 Primary care Kandy 47 180 1847 institutions Matale 18 62 573 Nuwaraeliya 24 98 1092 Central province 95 417 4607

Table 2.3 Total number of beds and beds per 1000 population in all government health institutions by District in 2017 (including line ministry institutions)

No of beds No. of beds per 1,000 population Kandy 6568 4.4 Matale 1687 3.2 Nuwaraeliya 1848 2.4 Central province 10103 3.6 Sri Lanka 83,275 (2017) 3.8 (2017)

ANNUAL HEALTH BULLETIN – 2018 Organization of Health Services

Central Province has bed strength of 3.6 (per 1000 people) closer to the national value. However, there is lesser number of beds (per 1000 people) within Nuwaraeliya District compared to other districts and national value. These values do not include the bed strength of the hospitals managed by estates and these hospitals also play a major role in provision of health care within Nuwaraeliya District. With the effective implementation of the government programme for estate health development which includes taking over of estate hospitals to the government, these values may also reach the national values. Table 2.4 Number of private hospitals and beds by District

No. of hospitals No. of beds Kandy 12 361 Matale 02 23 Nuwaraeliya 03 42 Central Province 17 426

Considering the private sector, Kandy district plays a major role in provision of health care through 12 private hospitals whereas Matale and Nuwaraeliya districts have 05 private hospitals each.

2.5 Health Manpower Table 2.5 The numbers of all Staff categories of health staff in Central provincial health department in 2018 (as at 31st December)

No Designation No. of staff 2018 1 Provincial Director of Health Services 01 2 Deputy Provincial Director (Medical Services) 01 3 Regional Director of Health Services 03 4 Director 02 5 Medical Superintendent 03 6 Medical Consultants 91 7 Consultant Dental surgeon 01 8 Medical officers 751 9 Dental surgeons 111 10 Regional Dental Surgeon 03 11 Bio Medical Engineer - 12 Engineer (Civil) 01 13 Engineer (Electrical) 01 14 Registered / Assistant Medical Officers 154 15 Chief Accountant 01 16 Accountant 03 17 Administrative Officer 04 18 Programming & Planning Officer 54 19 Medical Record Officer 01 20 Statistical officer 37 21 Statistical Survey Officer 02 22 Planning & Programming Assistants 01 23 Medical Record Assistant 05 24 Development officer 139 25 Public Management Assistant 224 26 Matron 11 27 Ward Sister 69 28 Regional Supervising Public Health Nursing Officer 04

ANNUAL HEALTH BULLETIN – 2018 Organization of Health Services

29 Tutor Nursing 02 30 Public Health Nursing Sister 32 31 Nursing officer 1371 32 Food & Drug Inspector 02 33 Health Education Officer 03 34 Supervising Public Health Inspector 21 35 Public Health Inspector 150 36 Supervising Public Health Midwife 41 37 Public Health Midwife 1076 38 Divisional Pharmacist 02 39 Pharmacist 72 40 Medical Laboratory Technologist 63 41 Public Health Laboratory Technician (PHLT) 29 42 Radiographer 17 43 E.C.G. Recordist 09 44 Ophthalmic Technologist 12 45 Physiotherapist 18 46 Occupational Therapist 06 47 Speech therapist 04 48 Dispenser 204 49 Electro Medical technician 03 50 Technical Officer (Electrical) 02 51 Technical Officer (Mechanical) - 52 School Dental Therapist 41 53 Ward Clerk 04 54 Data Entry Operators 02 55 Driver 196 56 Telephone Operator 09 57 Hospital Diet Steward 02 58 Cooks 01 59 House Warden 02 60 Hospital Attendants 649 61 Vaccinating Field Assistant 17 62 Entomologist 03 63 Regional Malaria Officer 01 64 Health Entomological Officer 15 65 Public Health Field Officer 49 66 Spray Machine Operator 46 67 K.K.S 06 68 Hospital Overseer 01 69 Unit controller 01 70 Thakshanika sahayaka (TA) 03 71 Watcher 125 72 Saukya Karya Sahayaka (Ordinary) 740 73 Saukya Karya Sahayaka (Junior) 629 74 Lab Orderly 02 Total 7361

ANNUAL HEALTH BULLETIN – 2018 Organization of Health Services

There is considerable increase of some staff categories such as Medical officers, Nursing officers, Pharmacists and PHM during 2017.

There were 10 medical consultants, 75 medical officers and 164 nursing officers respectively serving for 100,000 people in the Province within the health institutions in Central Province (including line ministry institutions).

Table 2.6 Cadre information of institutions under line ministry

Existing Cadre Designation TH TH DBH DGH SBCH Kandy Peradeniya Gampola Nuwaraeliya Peradeniya Medical Specialists 114 09 16 30 27 (Consultants) Medical Officers 809 208 97 92 131 Dental Surgeons 29 48 04 08 05 Nursing Officers 1945 659 198 265 248 Medical Laboratory 68 28 10 14 17 Technologists Pharmacists 66 34 14 17 14 ECG Technicians 15 07 04 05 04 Radiographers 31 16 04 06 08 Physiotherapists 33 08 03 08 06 Management 95 38 18 22 20 Assistants Hospital Midwives 43 38 16 28 Attendants 359 47 42 76 15 Ordinary Laborers 1215 501 51 126 34

ANNUAL HEALTH BULETIN – 2018 Curative care services

3. Curative care services

Curative care services are provided to the people in Central Province through a network of institutions. These include 3 tertiary care institutions, 8 secondary care institutions 153 primary care institutions and 18 specialized institutions. Six out of eight secondary care institutions, all primary care institutions and all specialized institutions of this network of healthcare institutions are come under the management of the Department of Health Services, Central Province. (Annexure 4)

Being a relatively large province with remarkable climatic and geographic diversity, the Central Province has a divergent population subjected to a wide spectrum of ailments requiring dynamism in the provision of healthcare services. High population density in the region has intensified this challenge with overcrowded health institutions badly demanding for improved infrastructure and efficient planning. Adding to this is the popular patient behavior pattern of bypassing the sequential process in which health care ought to be sought. This has inevitably led to a further congestion of the tertiary and secondary health care units while causing underutilization of resources at primary care level.

In year 2018, 2,836,775 people have attended for the OPD care while 703,645 people were seeking in-ward care from secondary and tertiary care hospitals. In contrast, there were 4,339,404 people having OPD care and 232,190 people having inpatient care from the 153 primary care institutes in the province.

As to fulfill the current healthcare needs, the provincial health department is utilizing the primary care institutions and primary medical care units to screening for and other controlling and prevention activities of non-communicable diseases. Elderly care services are also being delivered through some institutions. Remarkable steps on improving elderly care services including clinics and inward facilities have been put forward at Divisional Hospital Kadugannawa as the first Elderly Care unit established in Sri Lanka.

Secondary care institutions provide services mainly through the four common specialties including Medicine, Surgery, Pediatrics, Obstetrics & Gynecology and other specialties such as Orthopedic Eye, ENT and Dermatology. Essential supportive services including laboratory services and basic radiological services are also available at these institutions. The laboratory services consist of basic biochemical, hematological, bacterial and histopathological investigations.

3.1 Primary care services

Primary care services to the people in Central Province are delivered through Divisional Hospitals (DH) and Primary Medical Care Units (PMCU). In Central Province the total number of Primary care institutes stands at 153 as of 2018.

The Divisional hospitals provide both outpatient and inpatient care including the provision of basic health facilities for the treatment of minor ailments, referral to secondary and tertiary care institutions for further treatment, provision of prenatal care and follow up of patients referred from secondary or tertiary care institutions. On the other hand Primary Care Units concentrate on outpatient services.

ANNUAL HEALTH BULETIN – 2018 Curative care services

Although these institutions are also being developed to provide quality health care for the local area population, as aforementioned, the general trend is to seek medical care from secondary or tertiary care institutions, driven by the probable misconception that the bigger the hospital the better the care.

This has seen to a significant reduction in the bed occupancy rate at primary care institutions as compared to larger hospitals in urban areas of the province, attributing to the hazardously disproportionate utilization of available facilities. It is notable that the bed occupancy rate of primary care hospitals in the province is still below 40%.

3.1.1 Quality Improvement and Patient Safety assurance Project

In order to curb the unfavorable trend of underutilizing primary care institutions, through investigating the cause and resorting to preventive measures, Provincial Health Department undertook a project which looked into issues with regard to the quality and safety of health services provided to the patients in the primary and secondary healthcare systems. The project is based on the hypothesis that „patient satisfaction‟ is an outcome which is not only dependent on a pure clinical experience but also on the nonclinical aspects which instill a sense of dignity in the latter. Thus more emphasis was given to areas such as planning, management of human resources, financial & other resources, quality & safety with improvements, institutional organization and attitude development of the staff.

The initial stage of the project involved carrying out a situational analysis of 20 randomly chosen Primary Health Care Institutes in the Province. 43 areas from Divisional Hospitals and 27 areas from PMCUs covering a wide variety of aspects were assessed ranging from the general outlook of the hospital and availability of essential equipment at Emergency Treatment Units /Out Patient Departments to maintenance of Hospital Visitors‟ comments book.

Further, two audits were conducted separately to assess the satisfaction of the patients who attended the Out Patients Department & those who received inward care. Another was conducted to find the reason for patients to bypass the local hospital to attend a „bigger‟ hospital elsewhere. Through these studies it was concluded that there was a lot of scope to improve patient and staff satisfaction through the improvement of quality of services delivered by the institutions and thereby optimize the utilization of available resources.

Hence, a plan was drawn out to formulate a guideline for the improvement of quality of Primary Health Care Institutes and implement it in Provincial Hospitals by mid-2010. Further, it was proposed that it should be implemented with an accompanying Monitoring System under the direct supervision of a Medical Officer-Medical Services and the guidance of the respective Regional Director of Health Services. A progress of the program and encouragement to those hospitals which made achievements was given as a feedback to all the hospitals under the Provincial Council via a quarterly magazine named “Suwanetha”. A parallel project focusing the improvement of quality and safety of health institutions in Sri Lanka was piloted by mid-2009, in six Central Provincial Council hospitals. It was implemented by the Ministry of Health, Government of Sri Lanka with the support of the Japan International Cooperation Agency (JICA). The pilot hospitals that were chosen comprised of DGH Matale, DGH Nawalapitiya, DBH Dambulla, DBH Dickoya, DH Galewela and PU Thiththapajjala. District GH NuwaraEliya which is under the

ANNUAL HEALTH BULETIN – 2018 Curative care services

administration of National Ministry of Health was also included in the study. Deficiencies of services and infrastructure relevant to provision of quality care in these hospitals were identified through a situational analysis. Further, the circular “National Quality Assurance Programme in Health” was issued in September 2009 urging every health institute to begin a Quality Management Unit. Consequently the establishment of those units in the seven pilot project hospitals was facilitated through the equipment provided by the JICA in early 2010. Based on these studies, “National Guidelines for Improvement of Quality and Safety of Healthcare Institutions” were finalized by October 2010, and distributed among all Government Health Institutes. There are six volumes which are as follows: 1. Quality Series 1 – For Line Ministry and Provincial Hospitals 2. Quality Series 2 – For Primary Medical Care Units 3. Quality Series 3 – For Offices of Medical Officers of Health 4. Quality Series 4 – For specialized Public Health Units and Campaigns 5. Quality Series 5 – For Health Management Units 6. Quality Series 6 – For Training Institutions These volumes are freely downloadable from the Ministry of Health website via the following link: http://www.health.gov.lk/QSHI.htm In order to implement these guidelines and ensure its sustainability, it was proposed to establish a monitoring system by appointing a Medical Officer to the Quality Management Unit at each Regional Directors‟ Office. A National Health Excellence Award Mechanism was also to be implemented by early 2011 to provide a forum to recognize and share best practices and to encourage them. Provincial Quality improvement and safety assurance program was further strengthened by extending the program in to 45 institutions of the province which included 30 curative care institutions and 15 preventive care institutions. Based on the guidelines issued by the national quality directorate, provincial level unit was established with one unit in each district to implement the project.

Primary Health Care Institutes

Services delivered by Primary Care Institutions are summarized in table 3.1. Annexure five and six provide further information.

Table 3.1 Basic information and services delivered in primary care institutions (DHs & PMCUs) by District Kandy Matale NuwaraEliya Total 2017 2018 2017 2018 2017 2018 2017 2018 No. of Institutions 75 75 33 33 45 45 153 153 No.of beds 1842 1847 564 573 1125 1092 3531 3512 No.of wards 180 180 61 62 98 98 339 340 Bed occupancy rate 31.7 29.4 31.8 30.9 23.5 27.9 29.1 29.2 (%) No.of Admissions 126,296 119437 44170 41838 60401 70915 230867 232190

OPD Attendance 2674258 2586671 811373 719675 928741 1,033,058 4414372 4339404 Total inpatient days 213311 198673 65398 64636 96401 111370 375110 374679 per year No.of clinics held 7421 7916 3859 4841 3088 10106 14368 22863 Clinics Attendance 583,682 592232 197361 219659 171604 224327 952647 1036218 Total No. of Deaths 232 273 79 63 201 184 512 520

ANNUAL HEALTH BULETIN – 2018 Curative care services

Total No. of Deaths 154 177 45 55 48 59 247 291 Within 48 hours No.of Deliveries 488 409 86 90 627 419 1201 918 No.of patients 25,387 20588 6519 5965 8639 11192 40545 37745 transferred out No. of Emergency 47 47 14 14 22 22 83 83 Treatment Units (ETU) No. of patients 61,763 29521 22612 16498 19990 26455 104365 72474 treated in the ETU Compared to the year 2017, there is a decrease in OPD attendance and increase in Bed Occupancy rate. As Base and General hospitals upgraded their services, OPD statistics of primary hospitals are decreased.

A noticeable reduction in the deliveries at Primary Care Institutes is evident with a parallel increase in the deliveries taking place in Secondary Care Institutes. Number of mothers bypassing their local hospital in preference for secondary care hospitals for planned, uncomplicated deliveries is expected to be reduced with the implementation of aforementioned quality assurance programs.

The overall bed occupancy in primary care hospitals still remain below 40%. This further highlights the need to facilitating the improvement of care given at these institutes over the coming years.

Table 3.2 Services provided by primary care institutions in Central Province in 2017 & 2018

Table 3.2 compares the OPD & Clinic attendance, Inward Care and Deliveries in the years 2017 and 2018.

OPD Indoor Clinic attendance admission attendance Deliveries Kandy 2017 2,674,258 126,296 583,682 488 2018 2,586,671 119,437 592,232 409 % change -3.2 -5.4 1.5 -16

Matale 2017 811,373 44,170 197,361 86 2018 719,675 41,838 219,659 90 % change - 11.3 -5.3 11.3 4.6

Nuwaraeliya 2017 928,741 60,401 171,604 627 2018 1,033,058 70,915 224,327 419 % change 11.2 17.4 30.7 -33.1

Total 2017 4,414,372 230,867 952,647 1201 2018 4,339,404 232,190 1,036,218 918 % change -1.7 0.5 8.7 -23.5

ANNUAL HEALTH BULETIN – 2018 Curative care services

Fig.3.1 OPD Attendance in Primary Care Hospitals

5000000

4500000 4339404

4000000

3500000

3000000 2586671 2016 2500000 2017 2000000 2018 1500000 1033058 1000000 719675 500000

0 Kandy Matale Nuwara Eliya Total

Fig.3.2 Indoor Admissions in Primary Care Hospitals

250000 232189

200000

150000 2016 119437 2017 100000 2018 70915

50000 41837

0 Kandy Matale Nuwara Eliya Total

Number of inward admissions to the primary care institutions has been increased in year 2018.

ANNUAL HEALTH BULETIN – 2018 Curative care services

Fig.3.3 Bed occupancy Rate in Primary Care Hospitals

35 29.4 30.9 29.2 30 27.9

25 2016 20 2017 15 2018

0 Kandy Matale Nuwara Eliya Total

Bed Occupancy Rate in primary care institutions of the province has been increased in year 2018.

Fig.3.4 Clinics Attendance in Primary Care Hospitals

1400000 1215273 1200000

1000000

800000 2016 663794 2017 600000 2018

400000 306592 244887 200000

0 Kandy Matale Nuwara Eliya Total

There is an increase in Clinic attendance at primary care institutions of the province in 2018.

ANNUAL HEALTH BULETIN – 2018 Curative care services

Fig.3.5 No. of Deliveries performed in Primary Care Hospitals

2500

2000

1500 2016 2017 918 1000 2018

500 409 419

90 0 Kandy Matale Nuwara Eliya Total

There is a huge reduction of deliveries at primary care institutions over the years.

Fig.3.6 No. of Patients treated at ETU in Primary Care Hospitals

120000

100000

72474 80000 2016 60000 2017 2018 40000 29521 26455 16498 20000

0 Kandy Matale Nuwaraeliya Total

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.1.2 Emergency Treatment Units

Due to the unplanned nature of patient attendance, hospitals must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life- threatening and require immediate attention. Depending on the urgency of the condition it is also necessary to stabilize the patient before transferring to a higher level hospital for optimal management. Further, disorganized health care at the initial point of contact has been recognized as a significant cause of hospital deaths. All above factors have reinforced the importance of establishing Emergency Treatment Units (ETU) in Primary Health Care Institutes.

By 2018, the total number of Emergency Treatment Units was 83 in the Province and many more were proposed to be built with the ultimate target of an ETU for all hospitals. But all these existing ETUs are not according to a standard plan and order. The Department of Health Services, Central Province started standardizing the existing ETUs and while fulfilling all the basic requirements in year 2013. At the end of the year 2018 the department of health services central province was able to standardize all 83 ETUs of the province..

3.1.3 Laboratory Services

Many discussions are underway to upgrade the primary care institutions towards devising a system where the treatment of patients with minor ailments can be supplemented by basic investigations, to improve the quality and timeliness of referrals and to improve the follow-up of back referrals.

Respective catchment populations of 39 Health Institutions were being offered laboratory services by the end of year 2018. Further, it was proposed that these hospitals should be able to provide laboratory services not only to patients who attended their institutes but also to Primary Care Health Units in close proximity without lab facilities via a satellite laboratory system.

The department of health services, central province extended the laboratory services to primary care units in close proximity to the hospitals where laboratory services are available, by establishing the satellite laboratory system in year 2013. Under the satellite laboratory system, 308,570 laboratory tests have been performed in year 2017 and 236,475 tests performed in 2018.

Table 3.3 Laboratory Services –No of tests done in 2018

Hospital 2018 DH Wattegama 9373 DH Akurana 5275 DH Kaduganawa 7701 DH Galagedara 2700 DH Medamahanuwara 865 DH Ulapane 1367

ANNUAL HEALTH BULETIN – 2018 Curative care services

DH Katugastota 9052 DH Ankumbura 4685 DH Udadumbara 6989 DH Pussallawa 203 DH Minipe 425 DH Kotaligoda 821 DH Thalathuoya 1810 DH Kahawatta 120 DH Panwilathenna 96 DH Wattappola 44 DH Pamunuwa 1060 DH Hettipola 56163 DH Rattota 15019 DH Laggala Pallegama 840 DH Galewela 22312 DH Yatawatta 9261 DH Nalanda 37534

DH Sigiriya 224

DH Hattota-amuna 1845

DH Lenadora 1628

DH Ovilikanda 1137

DH Agarapathana 5346 DH Gonaganthanna 1206 DH Maskeliya 1794 DH Hanguranketha 1109 DH Nildandahinna 83 DH Udapussallawa 1935 DH Walapane 19141 DH North medakumbura 408 DH Kothmale 1033 DH Lindula 1184 Prison hospital Bogambara 3185 Prison hospital Pallekele 1502

Provincial steering committee was established to monitor the laboratory services towards providing high quality services and taken steps to get accreditation for laboratories in district general and base hospitals.

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.2 Secondary Care Services

Eight secondary care institutions provide specialized services to the people in the Province. In fact, DGH Nuwaraeliya and DBH Gampola are under the management of the National Ministry of Health, while the rest including DGH Matale, DGH Nawalapitiya, DBH Dambulla. DBH Dickoya, DBH Rikillagaskada and DBH Theldeniya are under the administration of the Department of Health Services, Central Province.

Table 3.4 Basic information on services delivered in Secondary care institutions – 2018

DGH DGH Matale DGH Nawalapitiya DBH Dambulla GH Nuwaraeliya BH Gampola DBH Rikillagaskada DBHDickoya DBH Theldeniya No. of wards 23 18 11 16 13 06 12 07 No. of beds 809 443 305 422 371 136 198 204 OPD attendance 334094 342271 203084 215565 375352 156313 121822 119159 Admissions 81180 41545 71195 55934 47765 22060 24617 16307 Bed occupancy rate (%) 63.7 54.6 100.2 91.0 62.1 68.8 86.4 40.3 Total No.of Inpatient Days 188012 88353 111527 140119 84134 34159 62464 29985 Total No. of inpatient Deaths 681 323 468 677 426 87 271 98 Total No.of Deliveries 5067 2957 2888 4651 3192 815 2178 259 Total No of Live Births 5085 2962 2901 4651 3201 815 2174 259 Total No of Maternal Deaths 0 0 0 0 0 0 0 0 Total No of Still Births 30 26 18 48 24 03 17 - Total No of patients Transferred out 1965 2188 1072 911 1388 2865 2153 2450 Minor operations done 9644 5025 7636 6137 4567 1375 2962 156 Major operations done 4722 2767 3953 5877 4053 743 1447 150 Total No of Clinics Held 3302 2320 1818 3165 1570 974 870 772 Total No of Clinics Attendance 271684 171508 115531 209280 163556 68061 62724 66840 No. of patients treated in the ETU 9653 6783 11932 29460 7971 13548 401 3104

In-ward care provided by secondary care institutions has undergone dramatic changes in the last decade as more and more patients seek in-ward care for non-communicable diseases like uncontrolled diabetes mellitus, hypertension which result in a prolonged

ANNUAL HEALTH BULETIN – 2018 Curative care services hospital stay. This accounts partly for the high bed occupancy rate in some specialized units of these institutions.

There was an increase in the attendance at special clinics in secondary health care institutions, probably due to increase awareness and early detection of diseases.

Fig. 3.7 Indoor admission in Secondary Care Hospital

90000 81180 80000 71195 70000

60000 55934

50000 47765 41545 40000 2016 2017 30000 24617 22060 2018 20000 16307

10000

District General Hospital Matale is the largest secondary care hospital in the province, providing inpatient care for the highest number of patients. The highest number of patients had been transferred out from the DBH Rikillagaskada during 2018 as it is still being developed and some of the major specialties are yet to be staffed.

ANNUAL HEALTH BULETIN – 2018 Curative care services

Fig. 3.8 Total No. of Deliveries in Secondary Care Hospital

6000 5067 5000 4651

4000 3192 2957 2888 3000 2178 2016 2000 2017 815 2018 1000 259 0

Fig. 3.9 Clinic Attendance in Secondary Care Hospital

300000 271684

250000 209280

200000 171508 163556

150000 115531 2016 100000 2017 68061 62724 66840 2018 50000

ANNUAL HEALTH BULETIN – 2018 Curative care services

Fig. 3.10 No. Patients treated at ETUs in Secondary care Hospital

35000

29460 30000

25000

20000

15000 13548 2016 11932 2017 9653 10000 7971 6783 2018 5000 3104 401 0

Compared to the Primary Healthcare settings, there is a huge difference in service provision from the secondary Healthcare institutions in terms of Clinic attendance, Inward admissions, Deliveries, and ETU admissions. This further indicates the need of strengthening the health care services at primary level. Generally there is an increasing trend of ETU admissions in all institutions.

Maternal and child health care services at secondary health care institutions showed a remarkable improvement over the last few years especially in terms of quality of service expecting a reduction in maternal and perinatal morbidity and mortality in the province.

Table 3.5 Maternal and new born Care Statistics of secondary care institutions under Central Provincial Health Department and National Ministry of Health

Type of Indicator

eniya

Matale

Dambulla

DGH DGH Nawalapitiya DGH DBH DBH Rikillagaskada DBHDickoya DBH Theld BHGampola GH NuwaraEliya No. of admissions to the 4659 6735 4030 1753 2749 858 4818 7060 Obstetric unit Daily average of maternal 13 18 11 05 07 02 13 235 admissions

ANNUAL HEALTH BULETIN – 2018 Curative care services

Total no. of deliveries 2957 5067 2888 815 2178 259 3192 4651 Single delivery 2926 5019 2859 812 2165 3160 4605 Twin delivery 31 48 27 03 13 31 44 Triplet delivery - 02 01 02 Mode of delivery Spontaneous delivery 1616 2684 1946 459 1658 259 1384 2955 Forceps delivery 91 12 21 15 30 06 23 Breech delivery 03 08 10 - 26 - 11 Vacuum extractions 01 01 05 03 - - 97 LSCS 1246 2362 906 338 464 1802 1565 Caesarean section rate % 42.14 46.6 31.3 41.4 21.3 56.4 33.6 Total no. of live births 2962 5085 2901 815 2174 259 3201 4651 Total no. of still births 26 30 18 03 17 24 48 Still birth rate (per 1000 LB ) 8.7 5.9 6.2 3.7 7.8 7.5 10.3 Total live Births by birth weight <2500g 571 764 432 99 1626 595 1366 >2500g 2391 4321 2469 716 548 2606 3285

Percentage of low birth weight 19.3% 15.0% 14.9% 12.1% 25.2% 18.5% 29.3% babies

Early neonatal deaths* 12 11 07 - 06 05 - - Early neonatal death rate (per 4.05 2.16 2.41 2.75 1.56 - 1000 Live Births) Maternal Deaths 0 0 0 0 0 0 0 Maternal death rate 0 0 0 0 0 0 (Per 100,000 Live Births) 0 * Also refer table 3.13 Note:  The perinatal mortality rate is the sum of early neonatal deaths and fetal deaths (stillbirths) per 1000 births.

In addition to curative care services, secondary healthcare institutes provide special preventive care activities such as rabies and tetanus vaccination.

Supportive services for curative care in secondary care institutions

3.2.1 Laboratory Investigations

The facilities required to perform investigations ranging from basic investigations including urine sugar, blood sugar to the more sophisticated investigations including renal function tests are available at secondary care institutions in CP.

In 2018the Provincial Secondary Care Hospitals had performed approximately 3,317,200 laboratory tests in total.

ANNUAL HEALTH BULETIN – 2018 Curative care services

Table 3.6 Summary of Laboratory Investigations done in secondary care institutions under Central Provincial Health Department and National Ministry of Health

Test category

Gampola

DGH DGH Nawalapitiya DGH Matale DBHDambulla DBHRikillagaskada DBHDickoya DBHTheldeniya BH NuwaraEliya GH Biochemistry 291174 377649 109953 39733 44607 41997 348101 225243 Bacteriology 21673 12920 31122 30990 10327 - 49219 7369 Haematology 409688 118293 119987 35357 120453 78147 156010 62725 Histopathology - 10196 1765 - - - - - Other 415727 141233 - - - 5542 - - Total 1138262 660291 262827 106080 175387 125686 553330 295337 Total No of MLTs 11 16 8 03 03 03 10 14 No of tests per 103478 41268 32853 35360 58462 41895 55333 21095 MLT per year

Fig. 3.11 Laboratory investigations handled by the secondary care hospitals

1200000 1138262

1000000

800000 660291 553330 600000 2016 400000 295337 2017 262827 125686 175387 200000 106080 2018

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.2.2 Radiology Investigations

Radiological investigations play a major role in curative care and are available from secondary care hospitals onwards. Five secondary healthcare institutions under the Provincial Council geared to provide basic radiological investigations including plain X- rays, Barium studies and special procedures like Micturition Cysto-Urethrograms (MCUGs). Further, these hospitals provide ultrasound scanning facilities as well. Existing radiology facilities will also be improved further with modern equipment (eg. X- ray machines with fluoroscopy facilities and CT scans) in the near future.

Table 3.7 Radiological investigations done in secondary care institutions

H Gampola H

DGH DGH Nawalapitiya DGH Matale DBHDambulla DBH Rikillagaskada DBHDickoya DBH Theldeniya B GH Nuwaraeliya No of OPD & 29618 6687 4774 1953 756 770 1748 11996 clinic cases No of Ward - 23966 15437 2261 5723 2747 9652 17477 cases Total of 29618 30653 20211 4214 6479 3517 11400 29473 patients No of other - - - - - 297 - - institute patients Ultra sound scans 7839 14626 8234 2045 3857 2597 6652 - Total No. Films 23206 45712 29352 7089 8898 4271 18446 - No. 04 05 03 01 01 02 04 06 Radiographers No. tests per 7404 6130 6737 4214 6479 1758 2850 4912 Radiographer per year

The department has been providing modern ultra sound scanning machines, modern X- ray machines, and other necessary investigation facilities for the secondary healthcare institutions.

ANNUAL HEALTH BULETIN – 2018 Curative care services

Fig. 3.12 Radiology Investigations handled by secondary care Hospital

35000 30653 29618 29473 30000

25000 20211 20000

2016 15000 11400 2017 10000 6479 2018 4214 5000 3517

3.2.3 Electrocardiography services

Electrocardiography (ECG) being an informative investigation for the management of many life threatening conditions ranging from ischemic heart disease to certain types of poisoning. This facility is a vital requirement for secondary care institutions and widely being used.

Table 3.8 ECG recordings done in secondary care institutions under Central Provincial Health Department and National Ministry of Health

H Gampola H

DGH DGH Nawalapitiya DGH Matale DBHDambulla DBH Rikillagaskada DBHTheldeniya DBHDickoya B Nuwaraeliya GH OPD 5854 12345 16251 8420 2116 1411 8298 4073 Clinics 4451 5549 7160 434 763 943 1456 Wards 48141 57097 60025 6542 2998 17135 33103 Total 58446 74991 83436 15426 5877 2354 26889 37176 No. of ECG 02 02 2 - 01 - 04 05 recordists No. of ECGs per 29223 18747 41718 - 5877 - 6722 7435 recordist per year

ANNUAL HEALTH BULETIN – 2018 Curative care services

Fig. 3.13 ECG Investigation done in Secondary Care Hospital

90000 83436 80000 74991 70000 58446 60000 50000

40000 37176 2016 30000 26889 2017 2018 20000 15426

10000 5877 2354 0

3.2.4 Blood bank services

Well-established blood bank is a mandatory requirement in any institution providing comprehensive maternal care services. Currently there are blood banks administered by the National Blood Transfusion Service, at all provincial secondary care institutions.

Table 3.9 Blood bank statistics of secondary care institutions under Central Provincial Health Department and National Ministry of Health

H Gampola H

DGH DGH Nawalapitiya DGH Matale DBHDambulla DBH Rikillagaskada DBHDickoya DBHTheldeniya B Nuwaraeliya GH No. of donors 2844 3415 1187 382 - - 2454 3080

No. of blood pints taken 835 775 205 260 1153 148 546 399 from other Blood banks

No. of blood pints issued 3346 3053 828 436 1482 68 2188 2629

No. of blood pints 346 328 180 61 55 - 541 - discarded

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.2.5 Physiotherapy Services

The Physiotherapy units at the DGH Nawalapitiya, DGH Matale and DBH Dambulla provide outpatient as well as inpatient services. These units have well trained physiotherapists supported by other required staff and are equipped to provide the appropriate therapy depending on the needs of the patients.

Details of the services provided are given in the table below. Table 3.10 Physiotherapy services at secondary care institutions under Central Provincial Health Department and National Ministry of Health

GH GH

DBH DBH

DGH DGH

H Gampola H

Theldeniya

DGH DGH Matale

Nuwaraeliya

Nawalapitiya

DBHDickoya

Rikillagaskada DBHDambulla

Total No of patients 21184 24440 10222 47940 4369 964 2004 16959 treated No. of Physiotherapists 03 04 01 08 01 01 02 03 Patients per 7061 6110 10222 5992 4369 964 1002 5653 Physiotherapist per year

Fig. 3.14 Physiotherapy provided in Secondary Care Hospitals

60000

50000 47940

40000

30000 24440 2016 21184 20000 16959 2017 10222 2018 10000 4369 964 2004 0

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.2.6 Surgeries Table 3.11 Surgeries conducted in secondary care institutions under Central Provincial Health Department

DGH DBH DBH DBH DBH BH GH Nuwara Nawalapitiy DGH Matale Rikillagaskad Theldeni Dambulla Dickoya Gampola eliya a a ya

Specialt

Major Major Major Major Major Major Major Major

Minor Minor Minor Minor Minor Minor Minor Minor

General 84 Surgery 3531 551 5575 292 6484 1549 2351 375 1122 311 3398 837 2936 639 Obstetric 66 - 790 2123 s - 1260 - 2424 - 909 - 504 - 290 1770 Gyneco logy 441 200 990 412 637 277 566 179 253 142 572 433 - - EYE 49 493 311 720 515 1218 45 389 275 852 943 2150 Dental and Maxillofacial - - 1554 150 ------644 111 E.N.T. 228 77 452 339 - - - - 322 161 270 85 Other 776 186 762 385 ------554 769 Total 5025 2767 9644 4722 7636 3953 2962 1447 1375 743 4567 4053 6139 5877 150

3.2.7 Special clinics Some secondary care institutions were unable to provide some specialized care due to shortage of specialists in their stations.

Details of the specialized clinics conducted by various specialties are as follows.

3.12 Specialized clinics conducted in secondary care institutions 2018

Specialty

Matale

Dambulla

DGH Nawalapitiya DGH DBH DBH Dickoya DBH Teldeniya Gampola BH GH Nuwaraeliya DBH DBH Rikillagaskada Medical 103 156 140 93 54 54 241 97 Surgical 99 97 98 84 50 46 96 99 Gynecology & Obstetric 190 101 189 50 94 48 98 48 ANC 96 92 - 48 48 95 101 E.N.T 161 94 47 10 19 - 94 95 Eye 148 234 109 04 146 - 144 193 Pediatric 189 96 97 98 48 48 98 99 Psychiatric 246 218 286 94 90 48 145 135 Dental and 313 538 286 311 - 300 293 602 Maxillofacial (OMF) Chest 17 294 24 24 24 - 24 315 Diabetic 104 64 129 47 51 24 - 146 Dermatology 208 143 237 61 42 48 194 204 Orthopedic - 64 ------Cardiology - 388 47 - - - - 116 STD - 310 - - 04 - - 258 Immunization - 95 - 50 49 - - - Neurology - 29 ------CKD 24 - - Other 446 289 105 151 84 48 618

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.2.8 Premature Baby Unit (PBU) Maternal and child care is always in top priorities of the healthcare sector as the origin of a healthy nation begins from the healthy mother and a baby. The department of health service central province has given its special attention to improve the quality of infant care in the province.

DGH Nawalapitiya, Matale and DBH Dambulla have well equipped premature baby units and other secondary care institutions also will possess the high quality facilities to provide these services in near future.

Table 3.13 Premature Baby Care in secondary care institutions under Central Provincial Health Department and National Ministry of Health

GH GH

DBH

DGH DGH

Dambulla

DGH DGH Matale

Nuwaraeliya

BH`Gampola

Nawalapitiya DBHDickoya 1 Admissions 501 525 689 81 596 425 2 Maturity < 28 weeks 10 13 06 02 09 16 28-36 weeks 125 137 86 27 133 177 > 36 weeks 366 375 597 46 454 232 3 Weight < 1000g 13 22 04 03 08 24 1000 – 1490g 34 30 23 11 34 83 1500 – 2490g 170 175 160 29 217 179 >2500g 283 298 502 37 337 139 4 Reason for admission Birth Asphyxia 20 07 02 03 07 11 Meconium Aspiration 17 19 24 04 20 04 Preterm 58 97 50 24 83 139 IUGR - 15 19 10 12 22 Grunting 56 55 49 18 66 57 Poor Sucking/lethargy 37 38 23 03 58 37 Gestational DM - 0 05 01 30 01 Congenital abnormality 07 15 07 02 27 16 Septicemia - 12 - - 293 - Jaundice - 50 - - - Fever - 21 - - - Other 301 196 496 17 138 5 Total Number of NND* 15 35 10 04 05 28 Number of early NND*(Deaths 11 18 07 04 05 12 within the first 7 days of life) 6 Cause of Death Prematurity 09 17 06 02 02 03 Birth Asphyxia + Septicemia 01 03 - 01 01 05 Congenital abnormality 01 07 03 01 02 12 Other 08 01 - - 7 Number Discharged 467 651 29 126 380 8 Number Transferred out 20 11 13 41 41 16

ANNUAL HEALTH BULETIN – 2018 Curative care services

* Includes Deaths of Transferred out babies Also refer table 3.5 Mortality during the neonatal period accounts for a large proportion of child deaths, and is considered to be a useful indicator to evaluate the quality and adequacy of maternal and neonatal healthcare.

3.2.9 Intensive Care Unit

DGH Nawalapitiya, DGH Matale, and DBH Dambulla have intensive care facilities and DBH Dickoya, DBH Theldeniya will start intensive care facilities when new building complexes start fully functioning soon. Having HDU facilities attached to the wards in secondary care hospitals reduces the demand for intensive care facilities, and thereby reduces the high cost of care. Hence the HDU facilities at secondary care hospitals will further be improved.

Table 3.14 ICU statistics in secondary care institutions under the Department of Health Services Central Province and National Ministry of Health

GH GH

DGH DGH

DGH DGH Matale

BHGampola

Nuwaraeliya

Nawalapitiya

BHDambulla DBHDickoya No. of ICU beds 05 04 03 06 03 05 ICU admissions 399 317 203 134 187 323 ICU deaths 88 83 64 17 57 78 ICU death rate 22.06 26.2 31.5 12.6 30.48 24.14

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.2.10 Hospital deaths

The numbers of hospital deaths which took place at all eight secondary care institution are given below.

Table 3.15 Hospital deaths which occurred in secondary care institutions under Central Provincial Health Department and National Ministry of Health

aeliya

H Gampola H

DGH DGH Nawalapitiya DGH Matale DBHDambulla DBH Rikillagaskada DBHDickoya DBH Theldeniya B GH Nuwar No of Deaths on admission 91 118 112 20 98 58 206 174 (OPD Deaths)

Inpatients deaths 323 681 468 87 271 98 426 677 Deaths within 48 hours of 37 383 277 66 164 57 265 - admission Deaths after 48 hours of 286 298 191 21 107 41 161 - admission Still births 26 28 18 03 17 - 24 48 Maternal deaths ------0

It is clearly evident that approximately 50% - 75% of the hospital deaths in these institutions occurred within 48 hours of admission which emphasizes the importance of improving emergency care in these hospitals as well as in other primary care hospitals from where they get transferred. Increasing number of on admission deaths at secondary care institutions also strongly suggest improving emergency care facilities at peripheries of the province.

3.3 Regulation of Private Health Services

Private Medical Institutions (Registration) Act was drafted in 2006, identifying the necessity and interest of providing a safe and efficient medical service for the people, to set out a National Policy in relation to the provision of medical services through private medical institutions, so as to regularize the manner in which such services are provided. Private medical Institutions registration was made a requirement by law and all Provincial Directors of Health Services are expected by law to facilitate registration of these institutions with the Private Health Services Regulatory Council and council members. Notice to this effect was given by Gazette notification No.1489/18 of 22nd March 2007 issued by the Minister of Healthcare & Nutrition. The law specifically outlines that the Private Health Services Regulatory Council shall provide registration to the institutions or premises to which the relevant application satisfies the criteria prescribed by the regulatory Council.

Consequently, there were 20 private hospitals based in the urban areas of the province receiving registration in 2014 under the Act. Additionally six medical specialists, 55 general practitioners and 11 dental surgeons providing full time care in the private sector while relatively a larger proportion of the Government employed medical

ANNUAL HEALTH BULETIN – 2018 Curative care services specialists, medical officers and dental surgeons are also practicing in the private sector on part time basis. Complementing these services are 31 medical Centers and 71private medical laboratories within the province. There are 31 medical centers and 71 private medical laboratories providing part time private medical services. The central province health department plays a vital role in strengthening the private health care service to people as to get registered all the private health care facilities from private hospital to other supportive care services such as private laboratories while ensuring the quality of the services.

3.4 Tertiary care services

All tertiary care institutions in the province are operated under the National ministry of Health Colombo, and institutions under the provincial health department are working in close collaboration with the tertiary care hospitals including Teaching Hospital Kandy, TH Peradeniya, and Sirimavo Bandaranayke Children hospital Peradeniya. Following tables summarize the information on available services and facilities in these Institutions.

Table 3.16 The bed strength and the services provided by tertiary care institutions in Central Province

TH TH SBCH Kandy Peradeniya Peradeniya No. of wards 78 20 10 No. of beds 2405 957 341 OPD attendance 394530 330452 244133 Admissions 232598 83592 26852 Bed occupancy rate 79% 80% 52.5% Total No.of Inpatient days 689946 279586 65316 Total No. of inpatient Deaths 2905 947 122 Total No of patient 739 3161 586 Transferred out Minor operation done 43403 6906 1794 Major operation done 22827 10839 2021 Total No of Clinics Held 12739 4287 3256 Total No of Clinics Attendance 1068442 364916 155181

Being the second largest hospital in Sri Lanka, Teaching Hospital Kandy handles the largest number of patients from the Province.

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.4.1 Maternity Statistics

Table 3.17 Maternity Statistics

Service/ Indicators TH Kandy TH Peradeniya

No.of admissions to Obstetric unit 12090 19127 Daily average of maternal admissions 33 52 Total no.of deliveries 9195 8022 Single delivery 9093 7935 Twin delivery 98 81 Triplet delivery 04 06 Other (4 babies) - - Mode of delivery Spontaneous delivery 5177 3972 Forceps delivery 130 07 Breech delivery 49 - Vacuum extractions/others 31 31 LSCS 3808 4012 Total no.of live births 9211 8054 Total no.of still births 90 61 Still birth rate (per 1000 live births) 9.7 7.5

Total live Births by birth weight >2500g 7521 6783 <2500g 1690 1271 Percentage of low birth weight babies 18.3% 15.8% Early neonatal deaths* 63 40 Early neonatal death rate (per 1000 LB) 6.84 4.9 Maternal Deaths 09 02 Maternal death rate (per 100,000 LB) 97 Manual removal of placenta 77 - Postpartum hemorrhage 34 -

3.4.2 Laboratory Investigations

Table 3.18 Laboratory Investigations

Test category

TH Kandy TH TH Peradeniya SBCH Peradeniya Biochemistry 980416 72171 162190 Microbiology 208937 67910 51566 Hematology 284076 236661 118856 Other - - 46569 Total 1473429 376742 379181 Total No of MLT 68 28 17 No of test per MLT per year 21668 13455 22304

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.4.3 Radiology Investigations

The total number of radiological investigations performed is significantly higher in the tertiary care units compared to the secondary care units.

Table 3.19 Radiology Investigations

TH Kandy TH TH Peradeniya SBCH Peradeniya No of OPD & clinic cases 28628 15695 No of Ward Cases 142205 3622 Total 170833 19317 23733 No. of other institution patients - - - X rays 112227 24214 9264 Total films 176737 31550 - Ultra Sound Scans 25771 13071 7354 CT Scans 27484 8027 5589 Imaging Magnetic Resonance 11830 - 1526 No of Radiographers 31 16 08 No. of tests per Radiographer per year 5510 1207 2966

3.4.4 E.C.G. services

Table 3.20 E.C.G. services

TH Kandy TH TH Peradeniya SBCH Peradeniya OPD 29762 15798 308 Clinics 6319 1936 Wards 88560 91364 865 other - - 421 Total 118322 113481 3530 No. of ECG recordists 15 07 04 No. of ECG per recordist per year 7888 16211 882

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.4.5 Blood bank services

Table 3.21 Blood bank services

TH Kandy

Blood Balance at the beginning of the year 838 Total No.of Blood taken from Donors 27408 No. of blood pints taken from other Blood banks 153 No. of blood pints issued 26383 No. of blood pints discarded 160 Blood balance at the end of the year 1350

3.4.6 Physiotherapy services

Table 3.22 Physiotherapy services

TH Kandy TH TH Peradeniya SBCH Peradeniya No of OPD Patients 45850 8928 - No of Clinics Patients 24323 4801 No.of Wards Patients 77372 51561 4991 No of ICU Patients 6139 Total No of patients treated 123222 84812 15931 No. of Physiotherapists 33 08 06 Patients per Physiotherapist per year 3734 10601 2655

3.4.7 Special clinics Held

Table 3.23 Special clinics held

TH Kandy TH Peradeniya SBCH Peradeniya Medical 787 570 179 Surgical 288 495 243 Antenatal 142 265 - Gynecology and Family Planning 502 684 - E.N.T 585 - 289 Eye 1163 - 229 Pediatric 237 539 -

ANNUAL HEALTH BULETIN – 2018 Curative care services

Psychiatric 215 458 - Dental and Maxillofacial (OMF) 457 283 - Neonatal Clinic - 180 227 Post-natal - 259 - Child Guidance Clinic - - 248 Cardiology 604 - 242 Chest 147 - - Orthopedic - 190 87 Orthodontic - - 289 Endocrinology - - 209 Immunization - - 48 Nephrology - - 120 Neurology - - 244 Diabetic 396 53 - Dermatology 339 - 136 Other 6877 311 466 Total No.of Clinics held 12739 4287 3256

3.4.8 Surgeries Table 3.24 Surgeries

TH TH SBCH Specialty Kandy Peradeniya Peradeniya Major Minor Major Minor Major Minor General Surgery 927 16272 2773 2761 1368 1309 Obstetric Gynecology 5644 2480 5917 1522 - - EYE 8173 2900 - - 206 74 Dental and Maxillofacial 142 3294 755 562 - -

E.N.T. 538 6140 433 404

Orthopedic 2256 5214 14 07

Urology 1507 3540

Neurology 1385 578

Onco surgery 408 170

Pediatric surgery 509 1058

Cardiothoracic 634 -

Plastic surgery 169 255

Gastrointestinal 241 157

ANNUAL HEALTH BULETIN – 2018 Curative care services

Nephrology 156 182

Vascular surgery 137 1163

Liver transplant 01 -

Other 1394 2061 Total 22827 43403 10839 6906 2021 1794

3.4.9 Premature Baby Unit (PBU)

Table 3.25 Premature Baby Unit (PBU)

TH TH SBCH Kandy Peradeniya Peradeniya

1 Admissions 967 1182 647

2 Maturity < 28 weeks 10 28-36 weeks 336 > 36 weeks 621 3 Weight < 1000g 22 1000 - 1490 g 96 1500 – 2490 g 365 >2500g 484

4 Reason for admission Birth Asphyxia 30 - - Meconium Aspiration 119 196 01 Pre Term 303 33 IUGR 51 Grunting 166 Poor sucking/lethargy 01 Gestational DM Congen. Abnormality Other 297 5 *Total Number of NND 56 47 6 *Number of early NND 32 40 22 (Deaths within the first 7 days of life)

7 Cause of Death Prematurity 26 11 06 Birth Asphyxia +Septicemia 08 04 04 Congen. Abnormality 04 Other 18 8 Number Discharged 475 1133 623 9 Number Transferred out 26 51 23

Includes Deaths of Transferred out babies

ANNUAL HEALTH BULETIN – 2018 Curative care services

3.4.10 ICU care

Table 3.26 ICU statistics

TH Kandy TH Peradeniya SBCH Peradeniya ICU admissions 63 572 542 ICU deaths 696 193 107 ICU death rate % 10.8 34 19.8

3.4.11 Hospital deaths

Table 3.27 Hospital deaths

TH Kandy TH Peradeniya SBCH Peradeniya

No of Deaths on admission (OPD Deaths) 114 112 06 Inpatients deaths 2905 122 Deaths within 48 hours of admission 1183 387 32 Deaths after 48 hours of admission 1722 560 90 Still births 90 61 - Maternal deaths 09 02 -

3.4.12. Emergency Treatment Unit

Table 3.28 Emergency Treatment Unit

TH Kandy TH Peradeniya SBCH Peradeniya

No.of Patients treated in the ETU 36592 26025 6507

No. of Transfers 29141 2074 26

Total No.of ETU Deaths (Within 24 272 82 08 hours)

ANNUAL HEALTH BULETIN – 2018 Morbidity and Mortality

4. MORBIDITY AND MORTALITY

Even though Sri Lanka has a good field surveillance system for communicable diseases, there is no proper field data collection method for other diseases, especially the non- communicable diseases. However, morbidity and mortality data on inpatient care at the government hospitals are available from different sources. . Data on outpatient care are not routinely collected except for the special surveys. Apart from these, data on both inpatient and outpatient care at the private institutions are also not available. In the government health system, indoor morbidity and mortality register (IMMR) has become the major source of information on these aspects.

4.1 Inpatient mortality and morbidity

Inpatient morbidity and mortality data are collected by individual hospitals through quarterly returns which are sent to the medical statistical unit, Colombo for further analysis. The timeliness of sending these data and quality of the available data are still not up to the expected standards. Curative care institutions of the Central Province have started e-IMMR parallel to the national programme, to overcome these issues.

The summary of Provincial and District data on leading causes of hospitalizations and hospital deaths (including line ministry institutions) for the year 2016 are shown in tables 4.1 and 4.2. As described earlier these data are analyzed by the Medical statistics unit, Colombo and the data are available only for the year 2017 at the moment.

Table 4.1 shows that persons encountering health services for Traumatic Injuries ranked top in hospital morbidity in all three districts. This clear evidence of a large number of patients with injuries admitting to the hospitals suggests the researchers and policy makers to think of new research studies and alternative solutions.

Ischemic heart disease has ranked in the top list of the hospital mortality in the Province, which may be compatible with the national figures. Neoplasms ranked as number 2 in hospital mortality.

ANNUAL HEALTH BULETIN – 2018 Morbidity and Mortality

Table 4.1 Leading causes of hospitalization in Central Province - 2018

Central Province Kandy

Disease and ICD Code No. Rank Disease and ICD Code No. Rank

Traumatic injuries (S00-T19, W54) 125,860 1 Traumatic injuries (S00-T19, W54) 65,134 1 Signs, symptoms and abnormal Signs, symptoms and abnormal clinical clinical findings (R00-R99) 76,281 2 findings (R00-R99) 43,321 2

Viral diseases (A80-B34) 60,704 3 Viral diseases (A80-B34) 42,109 3 Diseases of the resp. system Diseases of the resp. system exclu... exclu... (J20-J22, J40-J98) 57,107 4 (J20-J22, J40-J98) 32,592 4 Diseases of the gastrointestinal Diseases of the gastrointestinal tract tract (K20-K92) 40,657 5 (K20-K92) 24,065 5 Diseases of the urinary system (N00- Other obstetric conditions 33,277 6 N39) 21,539 6 Diseases of the urinary system (N00-N39) 32,278 7 Other obstetric conditions 18,478 7 Diseases of the eye and adnexa Diseases of the eye and adnexa (H00- (H00-H59) 29,889 8 H59) 14,717 8 Diseases of skin ad subcutaneous tissue (L00- Disorders of the musculoskeletal L08,L10-L98) 23,676 9 system (M00-M99) 13,957 9 Disorders of the musculoskeletal system (M00- Diseases of skin ad subcutaneous M99) 22,673 10 tissue (L00-L08,L10-L98) 13,649 10 Other dise. of the upper respir. tract (J00-J06,J30-J39) 18,628 11 Neoplasms (C00-D48) 13,137 11 Intestinal infectious diseases Other dise. of the upper respir. tract (A00-A09) 15,827 12 (J00-J06,J30-J39) 11,429 12 Intestinal infectious diseases (A00- Neoplasms (C00-D48) 14,782 13 A09) 9,276 13

Hypertensive diseases (I10-I15) 14,502 14 Ischaemic heart disease (I20-I25) 8,382 14 Ischaemic heart disease (I20- I25) 14,268 15 Hypertensive diseases (I10-I15) 7,740 15

Source – Medical statistical unit, Colombo

ANNUAL HEALTH BULETIN – 2018 Morbidity and Mortality

Matale Nuwara Eliya

Disease and ICD Code No. Rank Disease and ICD Code No. Rank

Traumatic injuries (S00-T19, W54) 33,514 1 Traumatic injuries (S00-T19, W54) 27,212 1 Signs, symptoms and abnormal clinical Signs, symptoms and abnormal findings (R00-R99) 20,839 2 clinical findings (R00-R99) 12,121 2 Diseases of the resp. system exclu... Viral diseases (A80-B34) 12,726 3 (J20-J22, J40-J98) 12,079 3 Diseases of the resp. system exclu... Diseases of the gastrointestinal tract (J20-J22, J40-J98) 12,436 4 (K20-K92) 7,934 4 Diseases of the eye and adnexa (H00- H59) 11,512 5 Viral diseases (A80-B34) 5,869 5

Other obstetric conditions 8,985 6 Other obstetric conditions 5,814 6 Diseases of the gastrointestinal tract Disorders of the musculoskeletal (K20-K92) 8,658 7 system (M00-M99) 4,352 7 Diseases of the urinary system (N00- N39) 7,168 8 Hypertensive diseases (I10-I15) 3,948 8 Diseases of skin ad subcutaneous tissue Other dise. of the upper respir. tract (L00-L08,L10-L98) 6,256 9 (J00-J06,J30-J39) 3,836 9 Disorders of the musculoskeletal Diseases of skin ad subcutaneous system (M00-M99) 4,364 10 tissue (L00-L08,L10-L98) 3,771 10 Other dise. of the upper respir. tract Diseases of the eye and adnexa (J00-J06,J30-J39) 3,363 11 (H00-H59) 3,660 11 Diseases of the urinary system Intestinal infectious diseases (A00-A09) 3,127 12 (N00-N39) 3,571 12 Intestinal infectious diseases (A00- Hypertensive diseases (I10-I15) 2,814 13 A09) 3,424 13 Dis. Of the ear …(H60- h61,H65-H74, H80-H83, H90-H95) 2,767 14 Ischaemic heart disease (I20-I25) 3,185 14

Ischaemic heart disease (I20-I25) 2,701 15 Diabetes mellitus (E10-E14) 2,985 15

Source – Medical statistical unit, Colombo

ANNUAL HEALTH BULETIN – 2018 Morbidity and Mortality

Table 4.2 Leading causes of hospital deaths in Central Province - 2018

Central Province Kandy

Disease and ICD Code No. Rank Disease and ICD Code No. Rank

Ischaemic heart disease (I20-I25) 752 1 Neoplasms (C00-D48) 586 1

Neoplasms (C00-D48) 681 2 Other bacterial diseases (A20-A49) 463 2

Other bacterial diseases (A20-A49) 645 3 Ischaemic heart disease (I20-I25) 430 3 Diseases of the resp. system exclu... Cerebrovascular disease (I60-I69) 611 4 (J20-J22, J40-J98) 407 4 Diseases of the resp. system exclu... (J20-J22, J40-J98) 600 5 Cerebrovascular disease (I60-I69) 407 4

Other heart diseases (I26-I51) 545 6 Other heart diseases (I26-I51) 282 6

Pneumonia (J12-J18) 430 7 Pneumonia (J12-J18) 225 7 Diseases of the urinary system (N00- Diseases of the urinary system N39) 310 8 (N00-N39) 221 8 Diseases of the gastrointestinal tract Diseases of the gastrointestinal (K20-K92) 241 9 tract (K20-K92) 169 9

Traumatic injuries (S00-T19, W54) 228 10 Traumatic injuries (S00-T19, W54) 153 10 Diseases of the nervous system Diabetes mellitus (E10-E14) 122 11 (G00-G98) 93 11 Diseases of the nervous system (G00- G98) 114 12 Diabetes mellitus (E10-E14) 89 12

Hypertensive diseases (I10-I15) 112 13 Hypertensive diseases (I10-I15) 80 13 Slow fetal growth, fetal malnutrition Congenital malformations and... (P05-P07) 90 14 deformations... (Q00-Q99) 68 14 Congenital malformations Slow fetal growth, fetal deformations... (Q00-Q99) 73 15 malnutrition and... (P05-P07) 54 15

Source – Medical statistical unit, Colombo

ANNUAL HEALTH BULETIN – 2018 Morbidity and Mortality

Matale Nuwara Eliya

Disease and ICD Code No. Rank Disease and ICD Code No. Rank

Ischaemic heart disease (I20-I25) 206 1 Other heart diseases (I26-I51) 146 1

Pneumonia (J12-J18) 144 2 Cerebrovascular disease (I60-I69) 119 2

Other bacterial diseases (A20-A49) 133 3 Ischaemic heart disease (I20-I25) 116 3 Diseases of the resp. system exclu... (J20- Other heart diseases (I26-I51) 117 4 J22, J40-J98) 88 4 Diseases of the resp. system exclu... (J20- J22, J40-J98) 105 5 Pneumonia (J12-J18) 61 5

Cerebroavascular disease (I60-I69) 85 6 Neoplasms (C00-D48) 50 6

Traumatic injuries (S00-T19, W54) 67 7 Other bacterial diseases (A20-A49) 49 7

Diseases of the urinary system (N00-N39) 62 8 Diseases of the urinary system (N00-N39) 27 8 Diseases of the gastrointestinal tract Neoplasms (C00-D48) 45 9 (K20-K92) 27 9 Diseases of the gastrointestinal tract Signs, symptoms and abnormal clinical (K20-K92) 45 10 findings (R00-R99) 24 10 Slow fetal growth, fetal malnutrition and... (P05-P07) 34 11 Hypertensive diseases (I10-I15) 16 11 Toxic effects of pesticides (T60.0,T60.1- Diabetes mellitus (E10-E14) 24 12 T60.9) 14 12 Toxic effects of pesticides (T60.0,T60.1- Toxic effects of ot. sub. oth. tha... (T36- T60.9) 22 13 T59,T61-T62,T63.1-T65) 13 13 Other conditions originating in the perinatal period (P00-P04, P08-P96) 20 14 Tuberculosis (A15-A18) 13 14 Signs, symptoms and abnormal clinical findings (R00-R99) 18 15 Diabetes mellitus (E10-E14) 9 15

Source – Medical statistical unit, Colombo

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

5. PREVENTIVE HEALTH SERVICES

Preventive health services are provided through a well-established network of Medical Officer of Health unit, which has the same geographical boundaries as the Divisional Secretary area. The Divisional Secretary areas with extreme large populations of over 100,000 have been divided to ensure that equitable manageable populations are covered within each MOH area. The structure and system ensures that all people receive the services required to minimize them getting any disease. The department has prepared a new cadre proposal according to national norms to meet the challenges ahead such as NCDs and issues pertaining to elderly.

This chapter includes information of activities on Maternal and Child health, School Health, Family Planning, Well Women Services, Epidemiological Services, Environment Health, Expanded Programme on Immunization (EPI), Health Promotion, Cosmetics drugs and devices and supportive supervision.

5.1. Maternal and Child Health

This chapter includes information on family health activities conducted by public health staff in the field and at clinics. (Clinics in the field and divisional hospitals)

Table 5.1 The population statistics, types of clinics done in 2017- 2018

Kandy Matale Nuwara-Eliya Total

2017 2018 2017 2018 2017 2018 2017 2018 Estimated Population* 1,451,909 1,399,277 514,666 520,180 756,662 763,884 2,723,237 2,683,341 Estimated eligible families 268,603 272,046 95213 96,233 134262 141318 498,078 509,597 Estimated number of births 25,503 24,464 8914 8,808 13291 13636 47,708 46,908 ANC 16 17 2 4 37 39 55 60 CWC 14 25 9 7 12 11 35 43 FPC 12 12 1 2 6 5 19 19 ANC/CWC 172 164 9 8 39 23 220 195 ANC/FPC 30 10 1 1 40 32 71 43 Number poly clinic 314 311 225 216 206 264 745 791 Number field weighing posts 2,065 2,065 995 995 1259 1097 4,319 4,157

* Department of Census and Statistics

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

Maternal and child health services had been provided through 122 Single Clinics, 238 Combined Clinics and 791 Poly Clinics at the end of the year 2018.

Table 5.2 Ante natal care services provided in the Central Province

Indicator 2017 2018 No. % No. %

Eligible families under care 484673 96.20 494378 99.60 Pregnant mothers registered by PHMM 46141 89.50 45,444 94.20 Pregnant mothers registered before 8 weeks POA 34653 75.10 34,398 75.69 Pregnant mothers registered before 12 weeks POA 42721 92.58 42156 92.76 Primi registered 14256 30.89 13,890 30.57 Pregnant mothers tested for VDRL at delivery 37449 97.90 37,653 98.50 Pregnant mothers blood grouping done at delivery 37785 98.80 37,921 99.20 Pregnant mothers protected with Rubella 45002 97.50 44420 97.70 Teenage pregnancies registered 1893 4.10 1752 3.90 Pregnant mothers with BMI < 18.5 kg/m² 6758 17.50 6,370 16.70 Pregnant mothers with BMI > 25.0 kg/m² 9549 24.70 10,117 26.50

The reported data in year 2018 indicate that 99.6% of the eligible families were under care of the Public Health Midwives out of estimated eligible families. Public Health Midwives have registered 45,444 pregnant mothers during year 2018 which is 94.2% of the estimated figure. Pregnant mothers registered before 8 weeks of gestations is improved in year 2018.

The registration of a higher percentage of pregnant mothers before 8 weeks shows that the both Public Health Midwives and families are aware on the importance of early registration. Out of all registered pregnant mothers, 3.6 % were teenage mothers. Service indicators such as VDRL coverage, Blood Grouping & Rh, Rubella were reported over 97%.

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

Table 5.3.Results of natal Care provided in the Central Province

2017 2018 Indicator Number % Number %

Deliveries reported by PHM 38,256 81.7 38,231 85.5

Home deliveries 49 0.13 50 0.13 Home deliveries receiving untrained assistance 36 73.7 39 78 Live births reported 36,842 77.2 36,677 78.2

Multiple births 623 1.69 615 1.67

Still Births reported * 254 6.89 302 8.23

Abortions reported 3856 8.73 3,988 8.77

Low birth weight 4895 13.5 4951 13.7

* Per 1000 LB

PHMM reported a total number of 38,231 deliveries during 2018 which was 85.5% of estimated deliveries. The rate of home deliveries was not changed during past years. Hence, Further efforts should be taken to discourage all home deliveries while investigating the causes to take preventive measures. Of the single live births, 13.7% were low birth weight (LBW, birth weight less than 2500gr). 3988 abortions were reported in the year of 2018.

Table 5.4 Post partum care provided by the Public health midwives

2017 2018 Indicator Number % Number %

At least 1 visit during first 10 days (of reported deliveries) 35572 92.95 36,063 94.33

At least 1 visit during first 10 days (of estimated deliveries) 35572 75.90 36,063 80.50 Post natal care around 42 day 28270 73.88 29,516 77.21

In 2018 the number of post partum visits during the first 10 days was 80.5% of the estimated deliveries. The post partum visits reported by PHM around the 42nd days was 77.2% in 2018.

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

Table 5.5 Post partum maternal morbidities reported in the Central Province

2017 2018 Indicator Number % Number % Post Partum Depression 33 0.09 34 0.09 Haemorrage 215 0.56 188 0.49 UTI 174 0.45 131 0.34

Infected Episiotomy 565 1.5 597 1.6 Separated Episiotomy 429 1.1 434 1.1 Foreign material in vagina 42 0.11 33 0.09

Infected caesarian section 880 2.3 922 2.4 Deep vein thrombosis 13 0.03 14 0.04 Postpartum psychosis 84 0.22 101 0.26 Engorged Breast 703 1.8 719 1.9 Breast abscess 53 0.14 45 0.13

Cracked nipple 379 0.99 318 0.83

Heart failure 13 0.03 8 0.02 Other 1837 1893 Total 4443 11.8 4400 11.3

Infected Caesarian section, Infected/ Separated Episiotomy, Engorged breasts were the most common postpartum complications reported by the public health midwives in 2018. Engorged breast is a preventable public health problem which needs improvement in awareness and support through MOH level.

Table 5.6 Infant care provided by Public Health Midwives

2017 2018 Indicator Number % Number %

Infants registered by PHMM 40728 87.0 40,260 89.8 Infant deaths reported by PHMM * 333 9.0 397 10.8 Infant deaths investigated by PH staff 238 71.47 336 84.63 Neonatal Deaths reported 242 72.6 283 71.2 Post neonatal deaths reported 91 27.4 114 28.8 Perinatal deaths reported * 441 11.7 446 13.5 Child deaths (1 -4 years) reported 81 53

* per 1000 LB

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

Infant and Neo-natal death reporting have been improved in 2018. Out of the deaths reported, 84.63% has been investigated by the PH staff.

Table 5.7 Growth Monitoring of children under 5 years by Public Heath Midwives

2017 2018 Indicator Number % Number % Average number of infants weighed monthly 35865 85.8 35233 86.2 Infants weighing below – 2Sd 2375 6.6 2409 6.8 Infants weighed below – 3Sd (severe underweight) 602 1.7 613 1.7 Infants weighed over + 2Sd (over weight) 79 0.22 93 0.22 monthly average children weighed 1-2 yrs 39594 87.4 34894 81.1 Number of Children 1-2 yrs weighing below -2Sd (moderate underweight) 4589 11.6 4334 12.4 Number of Children 1-2 yrs weighing below -3Sd (severe underweight) 1039 2.6 936 2.7 Number of Children 1-2 yrs weighing over + 2Sd (over weight) 86 0.22 77 0.22 Quarterly average of children 2-5 yrs weighed 120277 88.0 123331 82.7 Number of children 2-5 yrs weighing below – 2Sd (underweight) 14997 18.2 14446 18.0 Number of children 2-5 yrs who weighed below – 3Sd (severe underweight) 3130 3.8 2876 3.6 Number of children 2-5 yrs weighed who were above + 2 Sd (over weight) 199 0.24 178 0.22

The new WHO growth charts for girls and boys are included in the new Child Health Development Record (CHDR) which made it possible to identify children with moderately underweight (below – 2SD), severe under weight (below -3Sd) and also with the children over weight. 86.2% of the infants weighed monthly in 2018 which improved and is necessary to take timely action to prevent growth faltering.

Out of the children 1-2yrs weighed 12.4% were moderately under weight (<-2Sd) while 2.7% were classified as severely under weight (< - 3SD).

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

Data on Children 2-5yrs weighed, should be interpreted with caution as the reporting system gets only the number of times children are weighed monthly, hence the calculation is based on an assumption that children are weighed only once in three months. The percentage of children 2-5yrs under weighed was 82.7%.With the present health information system it is not possible to identify the percentage of infants who are weighed at least 9 times during their first years nor able to identify the percentage of children who are not weighed regularly. The moderate and severe underweight reported in the Nuwaraeliya District is much higher than the other two Districts, which is in line with all national surveys including the recent DHS 2006.

5.1.1 Maternal Deaths Pregnancy and childbirth are special events in women‟s life and in the lives of their families. Although pregnancy is not a disease but a normal physiological process, it is not free of risk to the health and survival of the mother as well as the unborn child. Any maternal death is a tragedy and also a social injustice for individual women, their families and their communities. Most maternal deaths are avoidable, and are therefore unacceptable. It has also been estimated that for every woman who dies, 30 – 40 women suffer from lifelong disability causing them to suffer for the rest of their lives. Sri Lanka is unique among countries in the South Asia region in that the maternal mortality has been reduced to a low level of around 39 per 100,000 live births. Despite the low national MMR figure a wide district variation exists. With such low figures of MMR all efforts need to be taken to prevent every single death.

The national MMR calculated for SL in 2017 was 39 per 100,000 LB.

Informative case summaries of MMR has been compiled at national level, NMMR discussion format has been changed to facilitate productive outcome, Cause of death has been categorized based on new WHO Classification, These attempt resulted in wider and timely dissemination of outcomes of NMMR and lead to translate lessons learnt into practice.

Table 5.8 Maternal Deaths according to classification in 2017

Kandy Matale NuwaraEliya CP Direct Maternal Deaths 04 01 00 05 Indirect Maternal Deaths 07 04 04 15 Inconclusive 00 00 00 00 No of Live births * 26152 8051 8560 42763 Maternal related Deaths notified 15 09 06 30 Estimated Number Births* 25408 8,955 12484 MMR (100,000 LB) ** 42.1 62.1 46.7 source – * Department of census and statistics ** FHB

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

Fig 5.1 Trends of Maternal Mortality Ratio by District of Central Province 2001- 2017

180

160

140

120

100 Kandy Matale 80 Nuwaraeliya 60 Sri Lanka

Source – FHB Nuwaraeliya district shows a decrease of MMR in year 2017. Hence, Matale and Kandy figure showed increase in year 2017

5.2 School Health The concept of “Kandurata Suwa Kekulu” the Health promoting school programme continues to be advocated in the province and is done in partnership with the Ministry of Education. At present nearly half of schools in the Central Province are adhered to health promoting school concept at different levels. Provincial Health and Education departments work together to strengthen this programme. A national circular from the Ministry of Education was circulated in October 2007 giving national guidelines on Health Promoting schools. School Health Provincial Steering committee is formed in April 2016. The identification of a marking scheme under 23 thematic areas has been circulated and an award scheme as Gold, Silver and Bronze certificates has been identified. School Health includes the areas of healthy school environment, school medical inspection and follows up, prevention of communicable diseases, nutritional services, first aid and emergency care, mental health, dental health, eye health, health promotion and use of school health records.

School medical services include medical inspection of children, detection and correction of health problems, provision of immunization, worm treatment, and micronutrients to needy children and advice on health issues. The public health inspectors conduct an annual sanitation survey in the schools in their respective areas. In 2018 sanitation survey has been completed in 1580 (97.17%). The SMI coverage in the Central Province

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services in year 2018 was 97.6%. This high coverage was achieved through the close collaboration and coordination with Ministry of Education.

Table. 5.9 School Health Activities in the Central Province

2017 2018 Indicator Number % Number % Total Number of schools 1581 1,626 Total number of schools sanitation survey completed 1551 98.10 1,580 97.17 Total number of schools with adequate drinking water facilities 1075 67.99 1,060 65.19 Total number of schools with adequate sanitation facilities 1185 74.95 1,465 90.10 Total number of schools SMI completed 1540 97.41 1,588 97.66 Number of children enrolled in year 1,4,7,10 133966 150,143 Number of children examined in year 1,4,7,10 119011 88.84 138,512 92.25 Stunted 7138 6.00 11,042 7.35 Wasted 35800 30.08 20,683 13.78 Over weight 5795 4.87 5,675 3.78 Total number of defects identified during SMI 55930 30,119 No. school health clubs functioning 274 17.33 274 47.65 Number of Health promoting schools 544 34.41 418 25.70

5.3 Well Women Clinic Services

The concept of well women clinics was introduced in 1996 to screen women for reproductive organ malignancies as part of the reproductive health programme. Ten years after initiation not only in the Central Province but also at national level the progress of programme has been extremely slow. The Family Health Bureau has changed the strategy to target at least the women reaching 35 yrs of age (cohort of 35yrs) during the past few years. The performance reported at WWCs in 2017 and 2018 is given in the table below.

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

Table 5.10 Performance in Well Women Clinics in the Central Province

2017 2018

Number % Number %

Total clinic sessions held 1866 2345 First visits to clinic age 35 yrs 15259 56.0 21075 78.5 First visits to clinic age 45 yrs 2624 No. of women subjected to breast examination 21644 29657 Breast abnormalities detected 271 465 Number Pap smear taken 19246 28096 Number reports received 12433 16992 ASCUS 21 38 LSIL 25 58 HSIL 0 9 Diabetes mellitus detected 457 555 Hypertension detected 617 909

Year 2018 is one of the best performing year in Well Women Clinic aspect. The Well Women clinic services are improved and reached national target coverage of 80% of the 35 year cohort. The First visit to clinic age at 35 years cohort is 78.5%. Nuwara Eliya District achieved the first place award in National level. Matale district also achieved Merit Award.

5.4 Family Planning

The distribution pattern of new acceptors is given in the table below. During 2018 a total of 35,886 new acceptors were recruited. It is higher than the new acceptors recorded in 2017. All kind of new Acceptors have been increased.

Table 5.11 Family Planning new acceptors

New New New New New acceptors acceptors acceptors acceptors Total New acceptors for for oral for for acceptors for IUCD injectable pills Tubectomy Implant 2005 4,825 16,873 5,754 184 Nil 27,636 2006 5,169 15,973 5,634 697 Nil 27,473 2007 7,774 13,647 5,841 702 Nil 27,964 2008 7,322 14,777 6,057 2,370 3,112 33,638 2009 5,988 14,692 5,445 2,401 2,608 31,134

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

2010 5,812 14,940 6,858 4,906 1,006 33,522 2011 5,787 16,780 6,786 2,399 2,319 34,071 2012 5,390 7,413 10,216 3,855 1,745 28,619 2013 6,470 7,481 7,558 3,531 5,143 30,183 2014 2,776 2,650 4,005 1,926 2,893 14,250 2015 5,945 6,718 7,046 4,081 7,244 31,034 2016 5,580 7,732 6,275 4,356 6,207 30,150 2017 4,425 7041 4,774 3,666 6,362 26,268 2018 4,978 10,740 7,308 5,055 7,805 35,886

Total number of new acceptors for modern methods markedly increased in 2018 compared to 2017.

5.5 Disease Surveillance

Surveillance of notifiable diseases is a major routine activity carried out in the Public Health system, where all Medical Officers of Health (MOH) sent the Weekly Return of Communicable Diseases (WRCD) to epidemiology unit with a copy to Regional Epidemiologist. Web based system of WRCD was started in 2015 and all 49 MOH divisions of the province enter the data regularly to the system by the end of the year. Provincial and district CCPs give technical guidance and supervise the system to make sure the quality of data by ensuring coverage, completeness and timeliness. MOHs are supposed to visit each of the hospitals in the area and all General Practitioners to assist in increasing notification. The number of cases notified in 2016, 2017and 2018 for the selected Notifiable Diseases in the Central Province is given below. Out of the notifications, majority of the cases reported were Dengue Fever and food and Water Borne Diseases. Increased incidence of typhus and leptospirosis has been identified during 2018.

Table 5.12 No of cases notified during 2016-2018

2016 2017 2018 Number Incidence Number Incidence Number Incidence per 100,000 per 100,000 per 100,000 population population population Dengue Fever 5380 200.0 17588 646.1 4536 164.9 Dysentery 347 12.9 178 6.5 174 6.3 Encephalitis 23 0.9 12 0.4 7 0.3 Enteric Fever 97 3.6 31 1.1 21 0.8 Food Poisoning 83 3.1 53 1.9 191 6.9 Leptospirosis 271 10.1 136 5.0 241 8.8 Typhus Fever 218 8.1 226 8.3 212 7.7 Viral Hepatitis 126 4.7 37 1.4 53 1.9 Source: WER

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

5.5.1 Surveillance of Leptospirosis

Table 5.13 Leptospirosis cases in the Central Province from 2008-2018

Year Kandy Matale Nuweraeliya 2008 537 849 76 2009 242 338 48 2010 141 195 36 2011 192 173 55 2012 85 52 43

2013 99 74 34 2014 76 41 37 2015 137 62 54 2016 112 81 55 2017 60 29 44 2018 123 91 27

Table 5.14 shows the number of Leptospirosis cases in Kandy, Matale and Nuwaraeliya districts from 2008-2018. The number of leptospirosis cases notified in all three districts show fluctuations with highest number in 2008. The cases reported have been decreased with slight deviations in some years in all three districts during past few years up to 2014. Though there was a significant case reduction in 2017 in all thre districts, there was a marked increase of number of leptospirosis cases in Kandy and Matale during the 2018. Nuweraeliya district shows the continuous reduction even in the yaer 2018. There has been a significant decrease in the number of leptospirosis cases reported in Central Province (CP) during the past few years. This is a result of implementing a multi sectoral plan prepared for high risk MOH areas in the CP to prevent the spread of the disease. Further action is required to maintain this trend and minimize the risk in future. The number of reported cases does not reflect the actual incidence of leptospirosis as patients with mild form of disease do not seek treatment at all or they are treated at OPDs or by private health care providers and these cases are generally not notified. Paddy cultivation takes place in most of the high risk areas and the peak incidence is observed during paddy sowing and harvesting seasons. Increase in rodent population in and around paddy fields during these periods contributing to this rise. This seasonal trend is important to be highlighted as it helps in planning preventive activities including provision of chemoprophylaxis to high risk groups. The decline in the number of deaths due to Leptospirosis in the province during past few years indicates the public awareness on importance of seeking early healthcare, which lead to early diagnosis and appropriate management by the healthcare providers.

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

Fig. 5.3 No of reported cases of Leptospirosis from 2008-2018

900

800

700

600

500 Kandy

400 Matale 300 Nuweraeliya 200

100

0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Further strengthening of prevention and control activities with the support of epidemiology unit at national level and other relevant sectors focusing more on environmental measures, improved disease surveillance, public awareness, intersectoral coordination, improved clinical management including laboratory surveillance and chemoprophylaxis needs to be further strengthened to reduce the disease burden in CP.

5.5.2 Surveillance of Enteric Fever Table 5.14 Enteric Fever cases in the Central Province from 2017-2018

Year Kandy Matale Nuwaraeliya Central Province 2017 9 14 22 45 2018 6 05 10 21 Source: WER

Total of 21 cases were notified in year 2018 which is a marked reduction than previous year.

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

5.5.3 Surveillence of Viral Hepatitis

Table 5.15 Viral Hepatitis cases in the Central Province from 2017-2018

Year Kandy Matale Nuwaraeliya Central Province

2017 15 09 11 35 2018 24 07 22 53 Source:WER

Total number of Viral Hepatitis cases reported in 2017 and 2018 was 35 and 53 respectively. The number of cases reported in 2018 were higher than the privious year in two districts except NE. No epidemics reported in the provinc in 2017and 2018.

5.5.4 Surveillence of Dysentry

Table 5.16 Dysentery cases in the Central Province from 2008-2018

Central Year Kandy Matale Nuweraeliya Province 2008 320 240 321 881 2009 365 169 423 957 2010 350 316 358 1024 2011 401 215 330 946 2012 136 131 186 453 2013 122 124 120 366 2014 104 81 256 441 2015 187 46 301 534 2016 156 23 88 267 2017 75 22 26 123 2018 117 15 42 174

Relatively higher number of cases of Dysentry were reported from Kandy district when compared with other districts in most of the years during past . A slight increse in the incidence of cases reported in 2018in the province than previous year deviating the trend of decrese the number.

5.6 Prevention and Control of Non communicable Diseases (NCD)

Sri Lanka has come a long way in control of communicable diseases, in improving maternal and child health, and virtually eliminating vaccine preventable diseases. During the past few decades chronic non-communicable diseases (NCDs) has been identified as the major health problem with the leading causes of mortality, morbidity, and disability in Sri Lanka as in many other countries. Aging of the population, urbanization and lifestyle changes are the key factors behind this epidemiological transition. A National NCD policy has been developed and the island wide NCD prevention and control program started in 2009.The major chronic NCDs causing a big burden in Sri Lanka are cardiovascular diseases (including coronary heart diseases

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

[CHD], cerebrovascular diseases [CeVD], hypertension, diabetes mellitus, chronic respiratory diseases, chronic renal disease and cancers.

NCDs, currently pose a major threat to health and development worldwide. Each year, 15 million people between the ages of 30 and 69 years die from NCDs; over 80% of these premature deaths occur in developing countries such as Sri Lanka. NCDs rank among the top 10 causes of premature death in Sri Lanka. In Sri Lanka, although people are living longer, they live more years suffering from disease and disability, mainly from NCDs; life expectancy at birth in Sri Lanka is 74.9 years but healthy life expectancy at birth is only 67.0 years. Few risk factors drive NCDs and death and disability due to them. They include tobacco use, harmful use of alcohol, overweight due to unhealthy diet and physical inactivity, air pollution and poverty. The key drivers of the NCD burden are population ageing, effects of globalization on marketing and trade and rapid urbanization. According to the most recent population based risk factor survey, among 18-69 year old Sri Lankans, prevalence of current smoking is 29% in males. About one forth have hypertension or raised blood cholesterol, one third are overweight or obese and 7.4% have raised blood glucose. Available data indicate that both indoor air pollution and ambient air pollution contribute to the rising NCD burden.

Policy Objective To reduce premature mortality (less than 65 years) due to chronic NCDs by 2% annually over the next 10 years through expansion of evidence-based health care services, and individual and community-wide health promotion measures for reduction of risk factors.

Key Strategies The following strategic areas were identified and prioritized

I) Support prevention of chronic NCDs by strengthening policy, regulatory mechanism and service delivery measures for reducing level of risk factors of NCDs in the population II) Implement a cost-effective NCD screening program at community level with special emphasis on cardiovascular diseases III) Facilitate provision of optimal NCD care by strengthening the health system to provide integrated and appropriate curative, preventive, rehabilitative and palliative services at each service level IV) Empower the community for promotion of healthy lifestyle for NCD prevention and control V) Enhance human resource development to facilitate NCD prevention and care VI) Strengthen national health information system including disease and risk factor surveillance VII) Promote research and utilization of its findings for prevention and control of NCDs VIII) Ensure sustainable financing mechanisms that support cost-effective health interventions at both preventive and curative sectors

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

IX) Raise priority and integrate prevention and control of NCDs into policies across all government ministries, and private sector organizations

The Provincial Department of Health has identified the need of strengthening the NCD prevention program as a priority and have established NCD units in each District in 2009/10. The NCD program unlike the more established program such as MCH, EPI, school health etc.., is just being established and programs are still being developed. The Ministry has identified the importance of having life style modification facilities in all out patients departments to facilitate screening of adults during hospital visits. It was decided at national level to have at least two Healthy Lifestyle Clinics (HLC) in each MOH area by 2018. HLCs are established at Hospitals and a referral hospital also identified for each HLC. Target population for NCD screening were people above 40 years old and they were invited to HLCs by using different strategies. In addition to screening of target population at HLCs, health promotion and primary prevention activities also carried out at provincial, district and divisional levels. Rehabilitation services as a tertiary prevention also established and strengthened gradually in the province. Relevant funds for trainings and other development has been spent from provincial sector development grant.

Table 5.17 NCD Activities in 2017 and 2018 Kandy Matale Nuwaraeliya Total Activity 2017 2018 2017 2018 2017 2018 2017 2018 Number of HLCs 32 41 27 27 44 46 103 114 6 9 5 5 Number of people screened at 2 6 hospital HLCs 4 9 4592 8892 17724 16959 28840 35420 2 1 3 4 4 5 Number screened at MOH 1 0 HLCs 1 0 414 445 6409 10296 30234 25241 1 2 7 3 Number screened at work 1 1 place 4 2 4420 7176 2838 2460 8972 11948 1 1 2 5 7 7 Tobacco users (Beetle) 1 6 985 1015 8508 10319 10764 12910 4 2 6 1 8 4 BMI<18 Kg/m2 0 0 566 2750 3678 4030 8924 8920 Blood pressure 120/80- 1 3 1659 3124 6850 8497 22238 14984

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

139/89 Hg 3 3 7 6 2 3 9 6 3 6 2 Fasting Blood glucose 90.0- 5 2 109mg/dl 6 4 584 5304 4991 4739 12231 13267 1 Number of people referred to 9 5 the primary health care 2 4 institutions 9 4 2519 1295 3039 3805 6487 6644 3 4 5 1 Number visited for follow up 6 1 care 0 0 3219 1668 24609 18483 31388 24261 5 9 Awareness program 1 7 63 45 55 51 169 193

5.6.1 Chronic Kidney Disease of uncertain origin (CKDu) in the Central Province

The problem of Chronic Kidney Disease of uncertain origin has been plaguing the country and drawing much attention of the Government, media and the public alike in the recent times. Due to its central location, Renal Unit of Kandy Teaching Hospital has being receiving a large proportion of these patients from all 5 adjacent provinces with recognized pockets for this disease. Within the Central Province, the main identified pockets for CKD are Hettipola-Wilgamuwa, Handungamuwa, and Maraka from where a significant number of patients have been identified.

CKDu High prevalent areas

Padavisripura

Padaviya

Medawachchiya Medirigiriya Dehiattakandiya

Giradurukotte Wilgamuwa

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

CKD prevention program in Central Province

Screening Program

Wilgamuwa MOH division, bordered to Girandurukotte, was identified as CKD prevalent area since 2009 and with reporting of cases a special CKD clinic was started at DH Hettipola with the support from Consultant Nephrologist, T.H.Kandy. Community screening programs were conducted in a planned manner during past few years in Wilgamuwa area and all the cases were referred to CKD clinic at DH Hettipola for follow up. There were about 711 CKD cases followed up at the clinic by the end of 2017 and around 75 cases out of them were on regular dialysis treatments. Consultant Nephrologists of TH Kandy attends the clinic once a month to attend referrals.

With the reports received from hospitals and media, it was decided to continue CKD screening program in Galewela, Dambulla, Naula and Laggala Pallegama MOH division in 2018 according to a plan to cover whole population of those areas above 10 years of age. A CKD clinic was established at BH Damulla in December 2015 and all the cases identified at those screening clinics were referred to BH Dambulla. There were about 143 CKD cases followed up at the clinic by the end of 2016. Consultant Nephrologists of TH Kandy attends the clinic once a month to see referrals.

There were CKD cases reported to TH Kandy and BH Mahiyanganaya from Minipe MOH division and, it was decided to conduct CKD screening program in Minipe the MOH division in 2016 and continued in 2017 and 2018, according to a plan to cover whole population of those areas above 10 years of age. The program was conducted with the financial assistance from line ministry. Technical assistant was provided by Provincial and District CCPs. Table 5.18 CKD/CKDu Screening Programme Matale District in 2018 - Number of people screened according to the target population and number positive

DS /MOH Target No of % of No Positive No of Division Population persons Screened CKD Urine Serum Screened persons Patients Albumin Creatinine +ve +ve

Dambulla 8978 1998 22.3 - 34 64 Dambulla MC 4409 863 19.6 - 06 08

Galewela 12968 5238 40.4 - 168 92 Naula 5717 4030 70.5 - 81 43

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

Vilgamuwa 6923 0 0.0 - 0 108 Laggala Pallegama 2241 1588 70.9 - 58 20 Total 41236 13717 33.3 - 347 335

Development of health care facilities for CKD treatment

With the increase of number of CKD cases in Matale district, a clinic, a laboratory and dialysis facilities in a new building were established at BH Dambulla with the financial assistance from line ministry in 2018. Dialysis services were further expanded in 2018 at the unit.

Community awareness and training on CKD

Community awareness and training programs were conducted continuously targeting health staff, community leaders, school children and community members in 2018. All the other sectors were also involved in community awareness programs including AGA and staff, water board, agrarian services, education and NGOs working in Wilgamuwa area. Risk factor reduction and health promotion were aimed at the community programs.

Community Based Rehabilitation

Community based rehabilitation program was started in Wilgamuwa area with support from AGA and team and community leaders of the area in targeting to improve welfare of affected patients and their family members.

All these programs were of guide by the ministry of health and provided with technical and financial support.

5.7 Food and Drugs activity

Table 5.19 Activities on Cosmetics and Drugs

Activities related to cosmetics devices and drugs-annual report 2017 & 2018

2017 2018 Kandy Matale Nuwara Kandy Matale Nuwara eliya eliya No of Pharmacies 205 64 53 203 67 56

No registered 192 62 50 185 65 53

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

No Unregistered 13 02 03 18 02 03

Drugs Sampling

Samples sent for analysis- 07 04 03 09 05 03 Formal Samples sent for analysis- - - 00 - - - Informal No Found unsatisfactory - - 00 - - 03

No of items withdrawn/withhold 21 - 02 16 - -

Quantity 1036 - 00 984 - - withdrawn/withhold(tab/cap)

Quality failure Drugs Report by the D.R.A.

No of circulars Received 06 06 02 04 06 07

No of items withdrawn/withhold 04 03 06 03 08 14

No of batches 03 02 00 03 08 02 withdrawn/withhold

Quantity 24 318 00 190 278 18000 withdrawn/withhold(tab/cap)

No of Flying Squad Activities 04 03 00 03 03 04

Unregistered - - 00 - - -

Prohibited - - 00 88/18370 - - Item - sample Storing under the Insanitary - - 750 - 24 270 condition Item Expired 32 04 750 16/397 02 06 Item Spoil & Damaged 04 - 00 - - 03 Item With State Logo Item - - 21 - 02 03

Storing Without a License - 14 00 - - 03 Item

Activities related to cosmetics devices and drugs-annual report 2017 & 2018 2017 2018 Kandy Matale Nuwara Kandy Matale Nuwara eliya eliya

ANNUAL HEALTH BULETIN – 2018 .. Preventive Health Services

No of Prosecutions 10 02 04 02 05 02

No Convicted 10 02 00 02 04 -

No Pending - - 02 - 01 02

Fines Imposed (Rs) 215,000.00 20,000,00 18,000.00 253,000.00 45,000.00 -

Cosmetics No of Manufacturing 01 01 - - - 01 establishment Smuggled 02 - - - - 02

Expired 03 10 - 07 - 03

Spoil & Damaged 04 03 - 03 - 04

No of Manufacturing 01 - - - - 01 establishment Seizures under the C.D.D.Act

Unregistered - - 00 - - -

Expired - 04 00 397 04 -

Spoil & Damaged - - 00 - -

Educational Programms

02 01 Pharmacy Owners/Assistance 02 02 02 02 Schools - 05 02 - 08 04

Others 04 04 01 32 10 06

Public Complains

02 04 No of Complains Received 02 02 03 13

No of Complains Investigated 02 02 04 02 03 13

The F&D Inspector play a key role to ensure that regular inspection of premises where cosmetics, drugs and devices are manufactured , stored and sold by taking samples , seizing and detaining any article which is in violation of the act and encourage proper licensing and also create awareness on responsible pharmacy management.

ANNUAL HEALTH BULETIN – 2018 .. Special Achievements

6. SPECIAL ACHIEVEMENTS

6.1 District Base Hospital- Theldeniya

Introduction & History Theldeniya hospital was established as a District hospital in 1954 and was shifted to present location in 1986 with Mahaweli Development Project. It was upgraded to a District Base Hospital in 2004, and development activities were started in 2013 with JICA aids. Hospital services have been extended with the establishment of new building complex and arriving of new consultants. DBH Theldeniya has 227 beds in seven wards, eight specialized clinics, Medical Imagine Department, 03 operation theatres; six bedded intensive care unit, PBU, JMO complex, ETU and OPD. Quality Improvements & Waste Management DBH Theldeniya has been improving its customer friendly environment, high quality safe patient care services and other facilities for the patients during the last few years. These quality improvements have been affected by the establishment of hospital quality management unit with 12 work improvement teams.(WIT). During 2018 Kaizen and lean concepts have been implemented to the hospitals to minimize waiting time and waste with process improvement. Hospital waste management system was reorganized with the establishment of new incinerator which also contributed to manage waste in other hospitals.

Vision of DBH Theldeniya “Healthier Dumbara community with sustainable healthcare service." Main objectives 1. Establishment & regular functioning of the QMU and WIT 2. Implementation of 5S and productivity concepts. 3. Ensuring the delivery of high-quality, safe patient-care services. 4. Improving service quality by applying "Kaizen," "Lean," “TQM” & error reporting system 5. Green productivity 6. Digitalization of the hospital patient management system 7. Staff training & welfare

ANNUAL HEALTH BULETIN – 2018 .. Special Achievements

Achievements in 2018  Provincial productivity award - central Province 2018 1st place – Curative care institution category  National Productivity Award – 2018 2nd place – Inter departments category  Healthy Life Style Clinic – The best Clinic in the Kandy district ( 1st Place)  Emergency Treatment Unit – The best ETU in Kandy district ( 1st Place)  Obtaining Environmental Protection License (EPL)

Provincial productivity award - central Province 20181st place – Curative care institution category

National Productivity award -2018 2nd Place

ANNUAL HEALTH BULETIN – 2018 .. Special Achievements

ICU

ANNUAL HEALTH BULETIN – 2018 .. Special Achievements

Lab

JMO Complex

ANNUAL HEALTH BULETIN – 2018 .. Special Achievements

Conference facilities

Sewerage treatment plant

Incinerator

ANNUAL HEALTH BULETIN – 2018 .. Special Achievements

Adopting to the Latest Technology District Base Hospital Theldeniya introduced e Health project with the help of Ministry of Health & ICTA. Main objective of this project was to create a digital health record for all individuals in Dumbara region. During 2018 nearly 60000 people were registered.

ANNUAL HEALTH BULETIN – 2018 .. Special Achievements

Welfare

ANNUAL HEALTH BULETIN – 2018 .. Special Achievements

6.2 Special events in 2018

01. “Suwa Abhimani” - 2018

Ceremony of Appreciation on Public health services in Central Province Department of Health services In 2018, this event was ceremonially held by the Department of Health services, CP to evaluate the public health staff. This event is carried out under two supervision process. 01. First stage – District level 02. Second stage – Provincial level

Accordingly, this evaluation is done in 49 MOH offices covering all public health services. In district level, 9 MOH divisions are selected which obtained higher marks. Among them first three places are selected at provincial level. These MOH offices are;

01. Medical officer of Health division Naula - Matale District 02. Medical officer of Health division Mathurata – Nuwaraeliya District 03. Medical officer of Health division Lindula - Nuwaraeliya District

Six MOH offices obtained appreciation certificates to provide optimum public health services to the community. 01. MOH division Pallepola 02. MOH division Kundasale 03. MOH division Kothmale 04. MOH division Galewela 05. MOH division Udunuwara 06. MOH division Gangawatakorale

This festival was held on 31st of July 2018 at 8.30 am at the Auditorium of Provincial council complex Pallekele. The Chief guest, Hon. Governor of Central Province, Chief

ANNUAL HEALTH BULETIN – 2018 .. Special Achievements

Minister of Central Province , Secretary of Ministry of Health,CP, special guests and health staff participated in this event. This ceremony is planned to be held annually in the CP.

First Place - MOH Division Naula Second Place MOH Division Mathurata

Third Place MOH Division Lindula

Central Provincial Poster competition on Dengue prevention - 2018

This competition was organized by Dengue control unit of Ministry of Health with the collaboration of Ministry of education for improving knowledge and making attitudinal change of school children on Dengue.

Organizing of competition- This was held by three rounds. Preliminary round is held on MOH level and first three places were selected. Second round was held by district level and third round was organized by provincial level for island wide competition. Winners of District level completion are mentioned below.

Place Name of school First St. Sylvester college, Kandy Second Rangiri Dambulla national School, Dambulla Third Mahabodi Secondary school, Pallepola

ANNUAL HEALTH BULETIN – 2018 .. Special Achievements

The winners of 1st, 2nd and 3rd place got cash rewards of Rs. 15,000.00, Rs. 12,500.00 and Rs. 10,000.00 respectively. Winning posters were sent to Dengue control programme for national level.

ANNUAL HEALTH BULLETIN – 2018 Special campaign

7. SPECIAL CAMPAIGN

7.1 Malaria control programme in Central Province (CP)

Sri Lanka was certified as malaria free country by 2016. Since then,there is no locally infected malaria cases in Sri Lanka. However, imported malaria cases are still being reported in the country and province. During the year 2017, there were 02 cases reported for the province and that was from Kandy. In 2018, 03 cases were reported from Kandy while 02 cases were reported from Matale. The sources of infection of the majority of these cases were from India and Africa. As a whole, Central Province shows a declining trend of malaria cases over the past few years.

This is a great achievement of the malaria elimination programme in the years 207 and 2018. Some of the very important contributory factors for this success were:

(1) Early diagnosis, prompt and appropriate treatment of cases, investigation and follow up of malaria cases to ensure complete cure including 14 days primaquine therapy for P. vivax and P. ovale cases,

(2) Making available of rapid diagnostic test kits (RDTs) for malaria diagnosis at key government and private hospitals, private laboratories and GPs with necessary training and guidelines.

(3) Timely application of remedial measures in receptive and vulnerable areas and around reported malaria cases that includes mobile malaria clinics and focal spraying,

(4) Institution of evidence based malaria control activities,

(5) Support given by the provincial and Central government authorities,

(6) Implementation of global malaria control strategies (GFATM Round 8),

(7) Institution of integrated vector control measures using long lasting insecticide treated bed nets (LLIN), chemical larviciding (abate) and biological agents (larvivorous fish) for larval control and source reduction wherever applicable,

(8) Conducting mobile clinics at remote areas targeting migratory populations such as traders, security camps, gem mining areas, development project sites and chena cultivation areas, for early detection and prompt treatment of malaria cases in order to eliminate the parasite reservoir in the human population.

In April 2008, the malaria control programme in the country embarked on pre elimination phase of malaria. Within this concept, the CP was placed as an area to maintain zero level indigenous transmission of malaria and mortality

ANNUAL HEALTH BULLETIN – 2018 Special campaign attributed to malaria. Thus, the objectives of the malaria elimination programme in the province are

1. To maintain zero level mortality attributed to malaria and

2. To prevent resumption of indigenous transmission of malaria in CP.

Occurrence of the major vector of malaria, Anopheles culicifacies, in previously malarious areas and project sites, and parasite reservoir among national and international migrant populations, make the province still remain highly receptive and vulnerable for malaria transmission.

Epidemiology of malaria in the Central Province

The number of malaria cases reported from 2001 – 2018 in CP are shown in Table 7.1.

Table 7.1 Number of malaria cases reported by districts from 2001-2018

Year Kandy NuwaraEliya Matale Central Province 2001 248 84 390 722

2002 150 19 228 397

2003 73 2 63 138

2004 14 1 75 90

2005 15 0 19 34

2006 5 0 07 12

2007 0 (4) 0 00 0(04)

2008 0 (17) 0 (4) 0(26) 0(47)

2009 0 (21) 0 (2) 0(27) 0(50)

2010 0 (33) 0 (0) 1(16) 0(49)

2011 0 (04) 0(00) 0(08) 0(12)

2012 0 (04) 0(00) 0(00) 0(04)

ANNUAL HEALTH BULLETIN – 2018 Special campaign

2013 0(04) 0(01) 0(01) 0(06)

2014 0(01) 0(01) 0(01) 0(03)

2015 0(01) 0(01) 0(00) 0(02)

2016 0(02) 0(02) 0(01) 0(05)

2017 02 0(00) 0(00) 02(00)

2018 03 0 02 05

** No. of imported cases are shown within brackets

In Kandy district, 53831 and 66571 blood smears were examined in the years 2017 and 2018 respectively. Of these blood smears, 03 were positive for P. vivax and 02 were positive from P. falciparum in 2017 and in 2018. In NuwaraEliya district 4605 and 12409 blood smears were examined in 2017 and 2018 respectively there was no cases positive from NuwaraEliya district in 2018. In Matale district, 34367 and 36060 blood smears were collected in 2017 and 2018 respectively and there were 02 cases positive from Matale district in 2018 but all were P. vivax case. (Table 7.2).

Table 7.2 Number of blood films, malaria cases and annual parasite incidence (API ) by district in 2017 and 2018

District Year No. of blood No. of P. vivax P. Mix API smears positives Falcifarum

Kandy 2017 53831 02 02

2018 66571 03 01 02 00

N Eliya 2017 4605

2018 12409 00 00 00 00

Matale 2017 34367 00 00 00 00

2018 36060 02 02

Entomological surveillance

In Kandy district, An. culicifacies, the principal vector of malaria was found in cattle baited net trap collection, cattle baited hut collection, human bait night collection (both indoors and outdoors) and in larval surveys.

ANNUAL HEALTH BULLETIN – 2018 Special campaign

An. subpictus, a secondary vector of malaria in Sri Lanka was not encountered in both years 2017 and 2018 in all three districts.

The density of An. culicifacies and An. subpictus in the CP are shown in Table 7.3.

Table 7.3 Entomological surveillance of Malaria by districts in the CP

2017 2018 District Method Indicator An. An. An. An. culicifacies subpictus culicifacies subpictus INRC No/hour 0 0 0 0 PSC No/room 0 0 0 0 CBT No/Trap 0.05 0 0 0 CBH No/Hut 0.27 0 0 0 Kandy WTC No/Trap 0 0 0 0 0 LS No/Dip 5.08 0 0.37 0 HBNC No/bait/hour 0.02 0 In-0 0 0 (in) (out) Out-0.03 ODC No/man hour 0.05 0 0 0 0 INRC No/hour 0 0 0 0 PSC No/room 0 0 0 0 CBT No/Trap 0.09 0 0.32 0 CBH No/Hut 0.02 0 0 0 WTC No/Trap 0 0 0 0 LS No/Dip 1.56 0 NuwaraEliya HBNC No/bait/hour 0.01 0 In-0 0 (in) 1.92 Out-0.03

ODC(out) No/man hour 0 0 0 0

LS Per Dip 6.37 0

PSC No/room 00 0 0 0

INRC Per house 00 0 0 0

CBTC(out) Per trap 0.07 0 0 0

Matale CB HC Per hut 2.88 0 0.80 0

WTC Per trap 00 0 0 0

HLNC Per man hour 0.01 0 0.008 0 (in) HLNC Per man hour 0.12 0 0.077 0 (out)

ANNUAL HEALTH BULLETIN – 2018 Special campaign

ODC Number Per 00 0 0 man hour LS Per dip 0.032 0 2.57 0

7.4 Indoor residual insecticide spraying

No of houses residual insecticide spraying was carried out District

2017 2018

Kandy - -

Nuwaraeliya - -

Matale 11 -

Indoor residual insecticide spraying has not been done in 2018 except in Matale district.

7.5 Distribution of long lasting insecticide treated bed nets (LLIN)

No of LLIN distributed District 2017 2018

Kandy 1065 1307

Nuwaraeliya 250 250

Matale 284 1872

In Kandy and NuwaraEliya districts 1065 and 250 LLINs were distributed in the year 2017 and 1307 and 250 in year 2018 respectively. In Matale district, 284 LLINs were distributed in 2016 and 1872 were distributed in 2018.

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Application of larvivorous fish

Table 7.6 Application of larvivorous fish, P.reticulata by district

District Year No. of permanent breeding sites No. of fish introduced

Kandy 2017 - - 2018 338 1075 NuwaraEliya 2017 - - 2018 - - Matale 2017 448 19412 2018 127 11826

Health education and community awareness programmes

Health education and community awareness programmes conducted in the years 2017 and 2018 are shown in table 7.6 and 7.7

Table 7.7 Health education and community awareness programmes conducted in Kandy and Nuwaraeliya districts

District Year Target group No. of No. of programmes participants

2017 School Children 04 462 01 Leaders (Intersectoral) 01 30 01 Consultant Doctors + MOO 01 80 02 GP 49 01 EA 01 10 01 PHI 01 37 07 PHLT 08 20 04 PHFO 01 15 01 SMO/SKS 01 15

Traveling agents 17

Army & Police Officers 380

High risk groups 192

Public Health Staff 108

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Community awareness 225

NO/ Pharmacist 18

MLT in private sector 20

2018 GP 01 30 01 Clinicians 01 41 01 Advocacy programme 01 35 01 NO/ pharmacist 01 25 01 Intersect oral working groups 01 30 02 SPHI 01 18 02 PHLT 02 12 01 EO 09 10

NuwaraEliya 2017 EAPublic health staff In Kandy01 0151 programmes PHLTPHFO 0122

PHFOSMO 0219

Army 92

School children 204 2018 GP 01 35 MLT (private sector) 18 Risk communities 01 20 Risk communities 325

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Table 7.8 Health education and community awareness programmes conducted in Matale distric

Target group 2017 2018

No. of No. of No. of No. of Programmes Participants Programmes Participants Community 68 1655 71 1877

Student 14 471 17 580

Institute Staff - - - -

Army Soldiers & police 03 71 - -

Government Institution 16 441 - -

Volunteers - - - -

Field staff 02 40 - -

Private Institution 03 94 04 112

Other - - 05 223

Tourist hotel - -

Total 106 2772 97 2792

In addition to malaria control, the anti-malaria campaign carries out dengue vector surveillance and chemical vector control including space spraying.

At present, the malaria control program focuses on maintaining of malaria elimination status in Sri Lanka. Thus, case detection and prompt appropriate treatment of imported malaria cases is of utmost importance where blood filming of fever cases is a key element. It is frequently observed that the malaria cases are not suspected and diagnosed at the first visit of the patient to a medical institution both at public and private hospitals, private laboratories and at GPs.

It is extremely necessary to make the clinicians aware about the prevalence of malaria among migrants and to suspect malaria in such people and to inform them as early as possible to the respective Regional officers/ Medical Officers of the Anti-Malaria Campaign Kandy and Matale and to the respective MOH immediately after detection/ suspected of such cases for institution of necessary remedial actions.

ANNUAL HEALTH BULLETIN – 2018 Special campaign

7.2 Surveillance of Dengue Fever/Dengue Haemorrhagic fever

Dengue fever is endemic in Sri Lanka as well as in Central Province (CP) and epidemics have been occurring with increased magnitudes periodically. The early action taken in Central Province lead to reduce morbidity and mortality levels during past few years. His Excellency the president established a presidential task force in May 2010 to combat the Dengue epidemic in Sri Lanka. The Provincial task force also was established in CP in parallel to national program. This further strengthened the District, Divisional and village level activities as the members of the police, armed forces and civil defense force were all mobilized to support the combat of the deadly epidemic. This was the first time that the police and armed forces were mobilized to combat a health emergency.

The dengue control activities conducted at Divisional level such as weekly monitoring of dengue breeding places in homes and institutions using a household card, local shramdana programmes, special cleaning up campaigns to reduce plastics in the environment were monitored at village and Divisional level. While all activities were monitored at Provincial level.

In addition to the routine notification, web based notification system was established by the NDCU in 2014 from sentinel hospitals and provincial, district and divisional level officers had the access to surveillance data. This daily notification of suspected dengue cases from TH Kandy, TH Peradeniya, BH Gampola, GH Nawalapitiya and GH Matale helped to take early action to prevent the spread of the disease. Hospital staff was trained on clinical guidelines on the management of dengue patients to strengthen the clinical management and reduce the case fatality rate.

Key strategies adopted in the province for Dengue control

1. Vector Surveillance and Integrated Vector Management

2. Disease Surveillance

3. Case Management

4. Social Mobilization

5. Outbreak Response

Dengue control activities were carried out in all three districts according to an annual plan with the financial support from National Dengue Control Unit in 2018.

Following were the key areas focused in carrying out dengue control activities.

• Reduction of the incidence of Dengue • Management of patients in preliminary care units, both private and Government, General Practitioners‟ OPDs emergency wards/HDUs etc as per guidelines

ANNUAL HEALTH BULLETIN – 2018 Special campaign

• Reduction of complication and mortality • Capacity building / Training • Inter-sectoral coordination and collaboration between stake holders • Establishment of institutional dengue prevention committees • Community mobilization and participation • Health promotion programmes aiming at sustainable behavioral changes targeting at the individual, household, and institutional levels • Monitoring and evaluation of control activities • Timely detection and reporting of all suspected dengue cases

Reported Dengue cases in each district from 2015 to 2018 are given in following graphs. Seasonal pattern was observed in all three districts as in other districts in the country according to rain fall.

Fig 7.1 Reported Dengue Cases in Kandy district in 2015 -2018

4000

3500

3000

2500

2000

1500

1000

500

0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 2015 244 161 71 68 54 78 68 44 58 163 133 164 2016 341 223 169 106 156 315 1168 482 261 173 106 295 2017 262 203 356 374 837 2309 3722 2253 1090 815 1094 754 2018 481 272 181 140 371 337 495 390 274 193 353 340

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Fig 7.2 Reported Dengue Cases in Matale district in 2015 -2018

800

700

600

500

400

300

200

100

0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 2015 98 45 19 20 10 8 5 0 7 11 9 4 2016 48 37 26 19 19 73 276 126 92 94 69 107 2017 110 108 122 121 165 408 741 547 182 119 258 160 2018 133 61 60 66 136 57 126 97 27 28 40 60

Fig 7.3 Reported Dengue Cases in Nuwaraeliya district in 2015 -2018

250

200

150

100

0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 2015 30 25 13 0 6 9 15 5 6 13 13 26 2016 42 22 20 28 12 34 109 45 13 11 9 21 2017 31 21 30 12 29 20 206 156 39 22 25 34 2018 21 12 9 8 15 6 30 13 17 7 9 15

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Table 7.9 Number and percentage of houses positive for Ae. aegypti/ Ae. albopictus in different MOH areas in the Kandy and NuwaraEliya districts 2017 2018 No. of No. (%) No. of No. (%) houses houses houses houses positive for Ae. surveyed positive for surveyed aegypti and Ae. District MOH area Ae. aegypti albopictus and Ae. albopictus

No No % % Akurana 3312 272 8.21 2960 247 8.344595 Bambaradeniya 456 16 3.51 678 43 6.342183 Doluwa 346 22 6.36 470 39 8.297872 Hataraliyadda 207 20 9.66 636 45 7.075472 Hasalaka 128 1 0.78 0 0 MC Kandy 253 84 33.20 1152 43 3.732639 Kundasale 2140 128 5.98 2251 168 7.463350 Udunuwara 1458 38 2.61 23315 47 0.201587 Poojapitiya 700 51 7.29 510 52 10.196078 Talatuoya 517 53 10.25 561 64 11.408200 Galagedera 1146 2 0.17 1620 138 8.518519 Gangawatakorale 1146 55 4.80 2576 275 10.675466 Kurunduwatta 123 15 12.20 416 30 7.211538 Menikhinna 972 100 10.29 2183 186 8.520385 Yatinuwara 2328 33 1.42 4646 117 2.518295 Gampola 4154 233 5.61 4927 287 5.825046 Nawalapitiya 994 30 3.02 1023 56 5.474096 Wattegama 3580 263 7.35 3443 236 6.854487 Werallagama 2289 192 8.39 4124 360 8.729389 Panwila 0 0 - 122 02 1.639344 Udadumbara 102 11 10.78 0 0 Galaha 115 8 6.96 147 06 4.081633 Medadumbara

575 47 8.17 753 65 8.632138 Kotmale 0 0 - Lindula 0 0 - Nawatispane 103 0 0.00 Rikillagaskada 419 36 8.59 Walapane 0 0 - NuwaraEliya Ambagamuwa 0 0 - Nuwara-Eliya 0 0 - Kotagala 0 0 - Bogawantalawa 0 0 - Maturata 0 0 -

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Table 7.10 Number of actual breeding sites of Ae. aegypti and Ae. albopictus in different MOH areas in Kandy and NuwaraEliya districts MOH area 2017 2018 No. of No. of containers No. of No. of containers houses houses surveyed surveye District Examined Positive d Examined Positive for Ae. for Ae. aegypti aegypti and Ae. and Ae. albopictus Albopictus Akurana 3312 2618 331 2960 2409 302 Bambaradeniya 456 478 14 678 778 48 Doluwa 346 475 24 470 584 47

Hataraliyadda 207 224 23 636 678 53 Hasalaka 128 241 1 0 0 0 MC Kandy 253 4538 89 1152 915 46

Kundasale 2140 3945 134 2251 2693 170 Udunuwara 1458 1203 37 23315 1227 51 Poojapitiya 700 1349 53 510 686 57

Talatuoya Kandy 517 1228 64 561 811 68 Galagedera 1146 1932 92 1620 1809 141 Gangawatakora le 1146 1974 58 2576 3126 361 Kurunduwatta 123 419 15 416 615 35 Menikhinna 972 1779 131 2183 2624 192 Yatinuwara 2328 2039 40 4646 2612 11 Gampola 4154 6648 290 4927 5271 350 Nawalapitiya 994 1603 32 1023 1167 62 Wattegama 3580 2937 303 3443 2312 295

Werallagama 2289 3748 201 4124 4185 386 Panwila 0 0 0 122 105 03 Udadumbara- 102 242 12 0 0 0

Galaha 115 276 8 147 129 06 Medadumbara 575 1087 82 753 973 74 Kotmale 0 0 0 Lindula 0 0 0 Nawatispane Nuwara 103 164 0 Eliya Rikillagaskada 419 619 48 Walapane 0 0 0 Ambagamuwa 0 0 0

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Nuwara-Eliya 0 0 0 Kotagala 0 0 0 Bogawantalawa 0 0 0 Maturata 0 0 0

Table 7.11 Number and percentage of potential breeding sites per 100 houses in the Kandy and NuwaraEliya districts

2017 2018

No. of No. of containers No. of No. of containers houses houses surveyed surveyed District MOH area Examined potential Examined potential breeding breeding sites per sites per 100 100 houses houses

Akurana 3312 2618 79.05 2960 2409 81.39 Bambaradeniya 456 478 104.82 678 778 114.75 Doluwa 346 475 137.28 470 584 124.26 Hataraliyadda 207 224 108.21 636 678 106.60 Hasalaka 128 241 188.28 0 0 0.00 MC Kandy 253 4538 1793.68 1152 915 79.43 Kundasale 2140 3945 184.35 2251 2693 119.64 Udunuwara 1458 1203 82.51 23315 1227 5.26 Poojapitiya 700 1349 192.71 510 686 134.51 Talatuoya 517 1228 237.52 561 811 144.56 Galagedera 1146 1932 168.59 1620 1809 111.67 Kandy Gangawatakorale 1146 1974 172.25 2576 3126 121.35 Kurunduwatta 123 419 340.65 416 615 147.84 Menikhinna 972 1779 183.02 2183 2624 120.20 Yatinuwara 2328 2039 87.59 4646 2612 56.22 Gampola 4154 6648 160.04 4927 5271 106.98 Nawalapitiya 994 1603 161.27 1023 1167 114.08 Wattegama 3580 2937 82.04 3443 2312 67.15 Werallagama 2289 3748 163.74 4124 4185 101.48 Panwila 0 0 - 122 105 86.07 Udadumbara 102 242 237.25 0 0 0.00 Galaha 115 276 240.00 147 129 87.76 Medadumbara 575 1087 189.04 753 973 129.22 Kotmale 0 0 - Lindula 0 0 - Nawatispane 103 164 159.22 Nuwara Rikillagaskada eliya 419 619 147.73 Walapane 0 0 - Ambagamuwa 0 0 - Nuwara-Eliya 0 0 -

100

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Kotagala 0 0 - Bogawantalawa 0 0 - Maturata 0 0 -

Container types

Water storage containers (Tanks and barrels), discarded containers, roof gutters and household appliances constitute the major proportion of Ae. aegypti and Ae. albopictus breeding sites. InNuwaraEliya district, the proportion of roof gutters is higher than that of the Kandy district. However, discarded containers are a major threat for dengue control in the province.

BI was varied from 0.24 to 14.01 in Kandy district in 2018. This shows the risk of spreading the disease in both districts during the given years.

Table 7.12 CI, HI and BI in different MOH areas in the Kandy and NuwaraEliya districts

2017 2018 District MOH area CI HI BI CI HI BI

Akurana 13.40 8.21 9.99 12.54 8.34 10.20

Bambaradeniya 6.25 3.51 3.07 6.17 6.34 7.08

Doluwa 7.16 6.36 6.94 8.05 8.30 10.00

Hataraliyadda 10.27 9.66 11.11 7.82 7.08 8.33

Hasalaka 1.85 0.78 0.78 0 0 0

MC Kandy 3.91 33.20 35.18 5.03 3.73 3.99

Kundasale 6.34 5.98 6.26 6.31 7.46 7.55

Udunuwara 5.28 2.61 2.54 4.16 2.03 2.20 Kandy Poojapitiya 6.97 7.29 7.57 8.31 10.20 11.18

Talatuoya 9.97 10.25 12.38 8.38 11.41 12.12

Galagedera 7.98 0.17 8.03 7.79 8.52 8.70

Gangawatakorale 5.61 4.80 5.06 11.55 10.68 14.01

Kurunduwatta 10.34 12.20 12.20 5.69 7.21 8.41

Menikhinna 11.68 10.29 13.48 7.32 8.52 8.80

Yatinuwara 3.72 1.42 1.72 0.42 2.52 0.24

Gampola 7.13 5.61 6.98 6.26 5.83 6.70

101

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Nawalapitiya 4.41 3.02 3.22 5.31 5.47 6.06

Wattegama 11.66 7.35 8.46 12.76 6.85 8.57

Werallagama 8.94 8.39 8.78 9.22 8.73 9.36

Panwila - - - 2.86 1.64 2.46

Udadumbara 7.41 10.78 11.76 0 0 0

Galaha 4.71 6.96 6.96 4.65 4.08 4.08

Medadumbara 13.95 8.17 14.26 7.61 8.63 9.83

Kotmale - - -

Lindula - - -

Nawatispane 0.00 0.00 0.00

Rikillagaskada 8.41 8.59 11.46

Ambagamuwa - - - NuwaraEliya Maturata - - -

Nuwara-Eliya - - -

Walapane - - -

Kotagala - - -

Bogawantalawa - - -

Dengue control programme- Vector surveillance Matale districts

Table 7.13 No of houses positive for Ae.aegypti and Ae.albopictu and No of containers positive for Ae.aegypti and Ae.albopictus in Matale district

No of Houses No of No of Houses positive for containers Ae.aegypti No of positive for surveyed and containers Ae.aegypti and MOH area Ae.albopictus Examined Ae.albopictus

2017 2018 2017 2018 2017 2018 2017 2018 MC -Matale 1721 1371 73 28 2299 1364 77 48

Matale 817 204 52 75 1237 2345 71 99

Yatawatta 200 300 13 43 110 618 13 45

Ambanganga/ 1079 1223 70 72 1637 1684 94 101 Rattota

102

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Ukuwela 3410 3468 160 134 4632 3711 192 142

Pallepola 402 754 38 49 503 862 44 58

Wilgamuwa - - 473 - 34 - 34

Dambulla 1081 800 36 58 1759 1087 52 71

Galewela 2037 712 98 56 2541 826 140 58

Naula 300 100 19 18 239 167 21 21

L/Pallegama 104 200 02 12 230 260 04 17

Institutions 66 100 86 86 1204 1073 86 56

Total 11217 9232 647 1104 16391 14031 794 750

Table 7.14 Dengue vector surveillance, Matale District - Other Premises 2017-2018

Institution No. No. No. positive for positive % of institutions examined examined for Ae.aegypti and positive for Ae.albopictus Ae.aegypti and Ae.albopictus

2017 2018 2017 2018 2017 2018 Government Offices / Institution 25 60 14 21 20 38

Schools 07 27 04 13 06 23

CTB Depot 01 - 01 - 01 02

Hospitals 07 02 06 01 09 02

Building site 313 - 06 - 09 -

Commercial site 1343 - 14 - 20 -

Religious place 15 09 06 04 09 08

Dump yard 65 - 12 - 18 -

Army Camps 02 - 02 - 03 -

Open Areas ------

Private 08 - 03 15 05 27

103

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Table7.15 Percentage of different containers types positive for Ae.aegypti & Ae.albopictus in Matale District 2016 and 2017

Container Type 2017 2018

Water storage 26 24 Discarded containers 35 36 Polythene 12 10 Natural 04 02 Tyre 08 09 Refrigerator 06 06 slab 03 01 Gutter 02 03

Ornament 03 06

Other 01 03

Fig 7.4 Percentage of Container Types among the Breeding Places - 2017

1 3 3 2 6 26

Water storage Discarded containers Polythene Natural Tyre Refrigerator slab Gutter Ornament Other

104

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Fig 7.5 Percentage of Container Types among the Breeding Places – 2018

3 1 6 3 24 6

Water storage Discarded containers Polythene Natural Tyre Refrigerator slab Gutter Ornament Other

Table 7.16 Application of larvivorous fish in water storage containers by MOH areas 2017 & 2018 in Matale district

No of permanent breeding No of fish introduced MOH Area sites 2017 2018 2017 2018 Matale 20 166 455 1630 MC Matale 0 0 Ukuwela 38 20 1070 Rattota 43 125 3260 770 Galewela 49 80 3847 590 Dambulla 104 198 3429 1740 L/Pallegama 0 0 Pallepola 06 140 750 1755 Yatawatta 73 196 1824 1565 Naula 115 165 4777 1170

Total 448 1090 19412 9220

9220 Larvivorous fish,Poecilia reticulata were introduced for water storage tanks in Matale district in 2018. The MOH areas and the number of fish applied given in the table above.

105

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Number of Rounds of space spraying in the MOH areas

Spraying was carried out according to national guidelines as a method to control the adult vector density. The number of rounds of space spraying in each MOH areas in Matale district is given below.

Table 7.17 Number of Rounds of space spraying in the MOH areas in Matale District

Amount of Insecticide used (Lit) No. of No. of patients rounds Technical MOH area covered Deltacide Pestguard Malathion

2017 2018 2017 2018 2017 2018 2017 2018 2017 2018

Dambulla -MC 02 09 0 1.0 12 1.85

Galwela 01 02 0 0.25 0

01M25atale 01 05 0 0.62 0 0.25

MC Matale 05 02 20 02 0 2.75 0 1.69

Naula 01 02 0 0.25 0

Pallepola 02 08 0 1.0 0

Rattota 03 10 0 1.25 0

Wilgamuwa 01 05 0 0.62 0

Ukuwela 12 02 28 02 0 2.375 07 0.655

Yatawatta 02 03 05 02 0 0.5 01 0.5

Laggala 00 00 0 00 0 0.5

Total 30 07 94 06 0 10.05 20 188.595

106

ANNUAL HEALTH BULLETIN – 2018 Special campaign

7.3 STD, HIV/AIDS Control Programme

Situation of HIV/AIDS and other STIs in the Central Province

Table 7.18 Clinic attendance and no. of newly diagnosed cases by District in Central Province 2017 and 2018

Kandy Matale Nuwaraeliya

2017 2018 2017 2018 2017 2018 Total Clinic 11029 13862 707 2767 1843 2233 Attendance Syphilis 28 37 08 11 15 08 NGU/NGC 98 128 46 64 15 18 Genital 157 171 56 76 33 16 Herpes Candidiasis 150 92 57 106 44 39

HIV 17 19 04 09 04 08 Gonnorrhoea 06 03 08 00 02 02 Other STIs 18 75 42 61 03 03

Total number of clinic attendance in all three districts has increased in year 2018 compared to 2017. NGU, Genital Herpes, candidaias and Syphilis were the major STIs in all three districts. In 2018, 19 cases of HIV positives were reported from Kandy District and also there were 9 and 8 cases reported from Matale and NuwaraEliya respectively.

Table 7.19 Serology test for Syphilis in Kandy District

2017 2018

Total VDRL VDRL +ve Total VDRL VDRL +ve

STI Clinic attendance 2261 89 2857 84

Ante-natal mothers 21444 61 21376 19

Pre – employment 2706 02 3508 02

Other 3813 42 1889 13

Total 30224 194 29630 118

The total number of VDRL tests carried out in Kandy district in 2018 was 29630 and 118 among them were positive. Number of VDRL tests carried out and test 107

ANNUAL HEALTH BULLETIN – 2018 Special campaign positives among antenatal mothers in Kandy district has decreased in year 2018 than 2017. Among them there were 19 VDRL positive antenatal mothers in Kandy district in 2018.

Table 7.20 Serology test for Syphilis in Matale District

2017 2018

Total VDRL VDRL +ve Total VDRL VDRL +ve

STI Clinic attendance 360 07 528 07

Ante-natal mothers 8513 00 9022 00 Pre – employment 1055 00 1061 00 Other 216 01 225 07

Total 10144 08 10836 14

Total Number of VDRL tests carried out in Matale district in 2018 were 10836 and 14 were positive for the test. Tests carried out for antenatal mothers were 9022, which is higher than previous year and none was positive for the test.

Table 7.21 Serology test for Syphilis in Nuwaraeliya district

2017 2018 Total VDRL VDRL +ve Total VDRL VDRL +ve

STD Clinic 405 16 436 08 Attendance Antenatal 10451 06 11159 Mothers Pre- 938 00 895 OthersEmployment 200 00 993 Total 11994 22 13483 08

Number of VDRL tests carried out among Antenatal mothers in Nuwaraeliya district have increased in year 2018 compared to 2017. In 2018, 08 of the pregnant mothers was VDRL positive whereas in 2017, this figure was 22.

108

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Table 7.22 Serology test for HIV in Matale District

2017 2018 No tested HIV Positive No tested HIV Positive STI Clinic 373 02 589 08 Attendance Ante natal 8492 01 9033 01 mothers Survey 825 00 samples Others 352 01 Total 10042 04 9622 19

There were 9622 serological tests carried out for HIV in 2018 and 04 cases were positive.

Table 7.23 Serology test for HIV in Kandy District

2017 2018 No tested HIV Positive No tested HIV Positive STI Clinic 2099 14 2984 16 Attendance

Ante natal 22647 01 21575 0 mothers Survey - - - samples Others 6641 02 3574 02 Total 31387 17 28133 18

There were 32387 serological tests carried out for HIV in Kandy district in 2018 and 18 of them were positive.

Table 7.24 Serology test for HIV in Nuwaraeliya District

2017 2018 No tested HIV Positive No tested HIV Positive

STI Clinic 405 02 475 08 Attendance

Ante natal 10451 02 11160 mothers

Survey 00 00 00 samples

109

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Others 632 00 1583

Total 11488 04 13218 08

There were 13218 serology test carried out for HIV in Nuwaraeliya district and 08 were positive.

7.4 Rabies Control activities

Rabies control program was launched in Sri Lanka in 1975 and were decentralized to the provinces in the early nineteen nineties. The Central Province initiated the rabies control activities through the mass dog vaccination and elimination of stray dogs. In 2006 Ministry of Health, Nutrition, and Indigenous Medicine revised the strategy to be more humane towards dogs by promoting dog sterilization instead of dog elimination. The CP has already implemented this strategy.

Goal

Elimination of rabies by 2020

Objectives

 To ensure protection for those who exposed to suspected rabies infection

 To establish herd immunity in animal reservoirs with special emphasis on dogs

 To control the animal reservoirs with special emphasis on dogs through appropriate methods

Strategies

 Provide appropriate post exposure treatments

 Provide pre exposure prophylaxis for those who have higher risk of exposure to rabies infections

 Immunize all dogs through mass vaccination programs to achieve 75% coverage

 Sterilize female dogs through appropriate surgical method

 Strengthen rabies surveillance

110

ANNUAL HEALTH BULLETIN – 2018 Special campaign

 Community awareness to reduce animal bites

Table 7.25Human Rabies Deaths

2011 2012 2013 2014 2015 2016 2017 2018

Kandy 00 00 00 01 00 00 03 02

Mathale 00 02 00 00 00 01 01 01

NuwaraEliya 01 00 ]00 00 00 00 00 00

Central 00 01 04 03 01 02 00 01 Province

Table 7.26 Post Exposure prophylaxis used in the central province 2009- 2018

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Human ARV Doses 41231 37625 25477 12722 36445 44414 23342 27067 22689 3

Human ARS Doses 18959 17942 11502 19857 8031 5496 5870 5860 13922

Table 7.27 The usage of Human ARV & ARS by Hospital in the Central Province 2017-2018

2017 2018 Institutions Human Human Human Human ARV ARS ARV ARS No of Vials No of Vials No of Vials No of Vials TH Kandy 5330 1589 TH Peradeniya 384 5526

BH Gampola 1746 580 2740 580

DGH Matale 3780 617 5277 435

DBH Dambulla 2555 939 5800 1020

DGH Nawalapitiya 109 2908

DGH NuwaraEliya 3056 221 00 186

BH Rikillagaskada 1416 00

111

ANNUAL HEALTH BULLETIN – 2018 Special campaign

BH Dickoya 1104 00 4094 00

DH Maskeliya 451 00

DH Walapane 457 00

DH Watawala 120 00 286 00

DH Udupussellawa 140 00

DH Bogawanthalawa 40 00

DH Lindula 110 00

CD Nildandahina 170 00

DH Madulla 85 00

DH Hangurankethe 00 00

DH Mathurata 60 00

DH Galewela 374 00

DH Wilgamuwa 315 00 999 00

DH Dayagama 43 00

DH Luxapana 240 00

DBH Theldeniya 00 883 1030 00

DH Delthota 00 582

DH Marassana 00 77

DH Hasalaka 152 00 512 00

DH Madulkele 452 00 720 00

Total 22689 13922

112

ANNUAL HEALTH BULLETIN – 2018 Special campaign

7.5 Respiratory diseases Control Unit

Tuberculosis (TB) continues to be a public health problem in the world despite the availability of extremely effective treatment regimens. Moreover, multi drug resistant TB and HIV are emerging threats for tuberculosis control. Sri Lanka continues to make a considerable contribution to the global efforts towards the elimination of TB.

Objectives of TB control Program in Sri Lanka

 To ensure that every TB patient has access to effective diagnosis, treatment and cure

 To interrupt the transmission of TB

 To prevent the emergence of drug resistance

 To reduce the social and economic toll caused by TB

Table 7.28 Incidence of Tuberculosis cases by type in Nuwaraeliya District 2017 & 2018

Type 2017 2018

PTB smear +ve 102 105

PTB smear -ve 70 47

EPTB 119 93

Total 291 245

Note: EPTB – Extra Pulmonary Tuberculosis

Table 7.29 Incidence of Tuberculosis cases by type in Kandy District 2017 & 2018

Type 2017 2018

PTB smear +ve 191 244

PTB smear -ve 133 140

EPTB 141 194

Total 465 578

Note: EPTB – Extra Pulmonary Tuberculosis

113

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Table 7.30 Incidence of Tuberculosis cases by type in Matale District 2017& 2018

Type 2017 2018

PTB smear +ve 72 70

PTB smear -ve 29 40

EPTB 51 67

Total 152 177

Note EPTB –Extra Pulmonary Tuberculosis

Table 7.31 Percentage Distribution of new smear positive cases by sex 2017 & 2018

2017 2018 District Male Female Male Female

Kandy 64 36 66 34 Matale 80 20 70 30 Nuwaraeliya 59 41 57 43

Central Province 66 34 64 36

Male have higher infection rates in all three districts in the province in both years.

Table 7.32 Distribution of TB cases by District

2017 2018

Kandy 465 578

Matale 152 177

Nuwaraeliya 291 245

Central Province 908 1000

Number of Tuberculosis cases diagnosed in CP was increased in 2018 when compared to 2017.

114

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Table 7.33 Clinic Attendance in CP

2017 2018 Category Number % Number %

Referral 9792 31 8467 27

Self referral 14422 45 15010 48

Contacts 1472 5 1967 6

Medicals 6303 20 5887 19

Total 31989 100 31331 100

Majority of the clinic attendees were self-referrals for both years in all three districts.

Table 7.34 No of Investigations Carried out and Results in CP

2017 2018

No of Smears Examined 37456 21072

No of Smears Positive Slides 1036 536

No of Smears Negative Slides 36420 16666

No of X rays Carried Out 18165 18117

No of Films Used 18384 18122

Table 7.35 Treatment success according to districts in 2017 and 2018

2017 2018

District Kandy Matale N eliya Kandy Matale N eliya

DOTS implementation 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% coverage

Treatment success rate 88.6% 60.52% 86.3% 98.9% 76.21% 80.4%

Default rate 0.8% 1.3% 2.6% 9.6% 0.6% 3.1%

The mortality rate 8.3% 10.52% 3.4% 5.4% 4.8% 3.5%

115

ANNUAL HEALTH BULLETIN – 2018 Special campaign

DOTS coverage in Kandy and Matale was nearly 100% in both years and Kandy and NuwaraEliya districts have better treatment outcome than previous years.

7.6 Leprosy control programme

The history of leprosy in Sri Lanka goes back to Dutch colonial times when segregation of patients started in the leprosy asylum at Hendala in 1708. For nearly 3 centuries, segregation of patients in the two hospitals, one at Hendala and the other at Mantivu Island, Batticaola was the main mode of control of leprosy.

Of all the diseases that occurred among human, leprosy has the most notorious history as a cause of deformity, disability, loathing and fear. From ancient times until the recent past, the disease was considered both highly contagious and impossible to cure. Victims were universally shunned; their physical suffering compounded by the misery of being treated as social outcasts. Even at the medical level the sole option for control was the isolation of patients in colonies or leprosaria.

During the last three decades, Sri Lanka has made much progress in eliminating leprosy. Invention and subsequent expansion of Multi Drug Therapy (MDT) by World Health Organisation (WHO) in 1981, was a dawn of new era in the path towards elimination of Leprosy. Well tolerance, effectiveness and high acceptance of MDT by patients led the way to the rapid cure of patients and interruption of further transmission of the disease. This invariably was the stepping-stone to the WHO resolution to eliminate leprosy as a public health problem by the year 2000. With the MDT and highly successful Social Marketing Campaign (SMC) which was launched in 1990, Sri Lanka reached the elimination target at national level in 1995, well ahead of the targeted year set by WHO. Just prior to dawn of the new millennium, Sri Lanka embarked upon integration of leprosy services into General Health Services, the final push towards the elimination of leprosy

Since 2001, Leprosy services have been completely integrated with the General Health Service to reach the final objective of achieving the elimination target in remaining few areas of Medical Officer of Health –MOH- (sub-national level) and to sustain the achievements gained so far.

7.6.1 Landmarks in the history of Leprosy in Sri Lanka

The landmarks in the history of leprosy in Sri Lanka can be grouped under four headings.

. Strict segregation (1708-1930)

. Evolution of field activities (1930-1970)

116

ANNUAL HEALTH BULLETIN – 2018 Special campaign

. Strengthening of field activities and introduction of Multi drug Therapy (1970- 1990)

. Community involvement and elimination as public health problem (Since 1990)

1. Strict segregation (1708- 1930)

1708 First leprosy asylum at Hendala in the Western Province

1868 Civil Medical Department took over the leprosy asylum from British

Military Administration

1901 Lepers Ordinance, which provided segregation of all leprosy patients

Compulsory was passed

1920 Second leprosy asylum was started in the island of Mantivu in the Eastern Province

2. Evolution of field activities (1930 - 1970)

1930 Two medical officers underwent training on leprosy control activities in Chingleput, India

1932 First leprosy survey

1933 First visit of Dr. Cochrane, The Medical Secretary to the Empire Leprosy

And Relief Association to Ceylon (Sri Lanka) to review the leprosy situation and make recommendations to the Government

1951 Introduction of Dapsone mono-therapy and special clinics for non-

Infective patients

1954 Appointment of Dr. B. L. Malhothra as a WHO consultant to the country.

Anti Leprosy Campaign (ALC), a vertical organisation under the Ministry of Health was started to co-ordinate leprosy control activities in the country.

1970 Appointment of trained, paramedical workers- Public Health Inspectors (PHIs) – to implement field activities

3 Strengthening of the field activities and introduction of Multi drug therapy (1970 – 1990)

117

ANNUAL HEALTH BULLETIN – 2018 Special campaign

1970 PHIs actively involved in field activities – clinics, Village surveys,

Defaulter retrieval, Contact surveys, Educational programmes

1977 Compulsory admission to two hospitals stopped

1983 Leprosy Relief Work Emmaus (ALES), Switzerland joined ALC with

Financial and material support for the field programme. Multi Drug Therapy (MDT) introduced. Sri Lanka achieved 100% coverage with MDT in the same year.

1987 Dr. Christian, WHO consultant arrived and National Leprosy Register was updated under his guidance and supervision. Names of the patients who were on Dapsone mono-therapy for many years released from treatment

i. Community involvement and elimination of leprosy at national level (1990 – 2000)

1989 Ciba-Geigy Leprosy Fund (now Novartis Foundation for Sustainable

Development -NFSD) joined Leprosy Relief Work Emmaus in supporting leprosy elimination activities

1990 NFSD funded, Social Marketing Campaign for Leprosy launched; blister packs introduced; number of field clinics increased from 76 to 210

1991 Case detection increased by 150%; Self reporting increased form 9% in 1989 to 50% in 1991

1992 Field based deformity care programme was started under the guidance of DrAtul Shah, a NFSD consultant

1995 Sri Lanka reached elimination target of leprosy at national level (Second country in South East Asia region to achieve – the first – Thailand)

2000 Goal Oriented Project Plan for integration of leprosy services into General

Health Service was presented to Hon Minster of Health, Health Administrators and other key stakeholders

2001 Leprosy Elimination activities in Sri Lanka which hitherto implemented through vertical component –Anti Leprosy Campaign- was integrated into Genral Health Service

2002 MDT distribution completely integrated with General Health Services

118

ANNUAL HEALTH BULLETIN – 2018 Special campaign

2003 Accelerated community awareness programmes launched in hitherto inaccessible areas in Northern province

2006 Exit of Novartis Foundation for Sustainable Development, Switzerland- one of the partners. Plan of action for sustaining the elimination and integration with Lepra.ch

Vision of the program

To reduce the Leprosy and Related Distress by reducing the reservoir of leprosy sustainable and by improving the quality of life of people affected by leprosy.

General objective

To reach elimination target at sub-national level (in remaining endemic MOH areas) with the integration of elimination activities into the General Health Services.

Specific objectives

1. To re-orientate curative medical officers of the GHS in the diagnosis and management of leprosy.

2. To train Regional Epidemiologists (RE), Medical Officers of Health - MOH) and the staff attached to those offices in the epidemiological assessment of leprosy at local level

3. To develop simplified records and registers and software on Leprosy Management Information System (LMIS) to facilitate the monitoring leprosy situation and maintaining the surveillance both at local and central levels.

4. To conduct awareness programme for general public to reduce the stigma and to inform the availability of drugs in all health units.

5. To make leprosy drugs (MDT blister packs) available in all health units.

6. To provide rehabilitative care for „cured‟ patients with disabilities

. New Case Detection Rate (New cases detected per 100,000 inhabitants)

. Disease burden in the population (Prevalence – cases per 10,000 inhabitants)

. Proportion of children among new cases (Child rate)

. New cases detected with disabilities (Deformity rate)

119

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Table 7.36 Incidence of leprosy by District in the CP from 2012 – 2018

2012 2013 2014 2015 2016 2017 2018

PB MB PB MB PB MB PB MB PB MB PB MB PB MB

Kandy 00 00 20 16 15 23 19 25 08 17 09 27 11 21 Matale 14 13 12 24 09 07 16 08 12 13 05 13 13 22 Nuwara 04 06 05 05 05 07 06 06 04 04 04 04 00 09 eliya Total CP 18 19 37 45 29 37 41 39 22 34 18 44 24 52  Source- sentinel Leprosy Register

When compare to the year 2017, in 2018 both PB leprosy and MB casesincreased in the province.

Table 7.37 Proportion Child patients and Deformities reported 2016 – 2017

2017 2018

Number % Number %

Child patients reported (< 15 yrs)

Kandy 02 5.56 02 5.56

Matale 01 5.5 03 8.57

NuwaraEliya 0 0 01 0.1

Total CP 03 06

Deformity patients reported

Kandy 07 19.44 06 19.00

Matale 01 5.5 01 2.85

NuwaraEliya 0 0 0 0

Total CP

 Source- sentinel Leprosy Register

120

ANNUAL HEALTH BULLETIN – 2018 Special campaign

Table 7.38 Treatment and rehabilitation status

2017 2018 Kandy Matale N Eliya Kandy Matale N Eliya

Number cured 32 15 04 30 22 04

Number defaulted 04 - 02 02 04 01 treatment Cumulative deformity patients 07 - - 06 05 02

Number patients received foot wear 22 03 00 25 08 00

Number of patients received foot splints - - 00 - 00 00

Finger splints - - 00 01 00 00

Ulcer care kit 05 - 00 06 00 00

Large plastic basin - - 00 - 00 00

MC for social relief allowance 14 02 00 14 04 00

The incidence of leprosy was decreased in the province in 2018 than 2017.

121

ANNUAL HEALTH BULLETIN – 2018 Special Units

8. SPECIAL UNITS

8.1 Patient Rehabilitation Services

Rehabilitation Hospital –Digana

The rehabilitation of physically disabled patients is an aspect that fails to draw adequate attention in the general health services due to lack of facilities and trained staff. When patients needing medium and long term rehabilitation get discharged without a proper plan they end up as wheel chair or bed bound patients. This has been highlighted by data from previous years. In 2001 with government and other well-wishers‟ donations, the Department of Health Services Central Province decided to develop a Rehabilitation Hospital in the underutilized rural hospital at Digana (about 15 km away from Kandy town). The available services are  Inward facilities

By 2018 the total number of beds at the hospital were 68 and the total inpatient days been recorded was 17,773 for the year. Bed occupancy rate was 70.85%.

 Medical Management

A main challenge faced when dealing with these patients is being sensitive to the sudden transformation they have undergone from being healthy, independent individuals to those who are physically, mentally and personally disadvantaged. Thus, the management of these patients by the hospital staff extends well beyond boundaries of straight forward medical treatment.

Rheumatology Services

These services are provided for  Inward patients  Out patients  Follow up services

122

ANNUAL HEALTH BULLETIN – 2018 Special Units

Community Pediatric Services This pilot project involves the early identification of disabled children and education of field officers by the community Pediatrician in order to enable early referral of these patients to a rehabilitation centre. The areas that covered with this project are Ududumbara, Wattegama and Galagedara. Pediatric Services In addition to inward treatment following clinic services and follow up services are also provided through this department.  Development screening clinic  General Pediatric clinic  Learning disability clinic  Pediatric Neurology (Joined clinic)  Autism & child guidance clinic

Special Ward Rounds The ward round is carried out with the participation of a multidisciplinary team consisting of a consultant Rheumatologist, Medical Officers, Physiotherapists, Occupational Therapists, Speech Therapists, Planning officer, Social services officer and Nursing officers. During the ward round, ideas and suggestions from each category are shared in order to individualize and optimize patient care services.

 Physiotherapy

Physiotherapy department is well established unit with adequate facilities and equipment. Eight qualified physiotherapists are working in this department and consist of specially designed area for pediatric patients.

Physiotherapists in the hospital are responsible in restoring functions and independence of the individuals who have disabilities or problems caused by physical psychological and other disorders; promote the health and wellbeing of the whole person to an optimal level of function and independence.

This professionals individually assess the patient and plan their treatment protocols according to evidence based studies and deliver treatment using physical agents, force, gravity, bouncy, sound and manual techniques. As well as patient and their families are educated by physiotherapists.

They always work collaboratively with multidisciplinary team in order to achieve an effective outcome.

Physiotherapy department provides treatment for inward adult and pediatric patients as well as adult and pediatric out patients who need physiotherapy interventions to overcome their disease and disorders.

Aims of physiotherapy  Evaluate physical problems  Increase and maintain muscles strength and endurance  Restore and increase range of motion in joints

123

ANNUAL HEALTH BULLETIN – 2018 Special Units

 Increase coordination  Decrease pain  Decrease muscle spasm and spasticity  Decrease swelling / inflammation of joints  Promote healing of soft tissue lesions  Prevent contractures and deformities of limbs  Alleviate walling problems  Educate patients and families about their care  Decrease stress  Reline a number of respiratory problems including asthma

“PHYSIOTHERAPISTS HELP PROMOTE POSITIVE ATTITUDES TOWARDS HEALTH AND FITNESS”

124

ANNUAL HEALTH BULLETIN – 2018 Special Units

 Occupational Therapy Occupational therapy is one of health profession in western medicine with using therapeutic activities for physical and mental conditions.

Occupational therapy department well established with various facilities and therapeutic equipment. Four qualified occupational therapist are working in this department.

They work collaboratively in adult occupational therapy unit and pediatric occupational therapy unit separately.

Occupational therapists work with physically and mentally disabilities. Such as neurological, Rheumatologic, Orthopedic, burns, Pediatrics, cut and crush injuries of the hand geriatrics and many other conditions.

Occupational therapists can assess and provide various facilities in hand injury management, physical improvement for function, activity of daily living, psychological support, Wheel chair assessment, work school, home and community reintegration.

Specific activities are treatment media of occupational therapy following area list of such activities.

125

ANNUAL HEALTH BULLETIN – 2018 Special Units

 Provision of special attention and care to stroke patients to improve their mental status.  Identification and training of specific movements needed by an individual to carry activities of daily living.  Patients with paralyzed upper limbs are trained to explore the ability to reuse them by using adaptive devices and splints.  Assessing the suitability to use a wheel chair and the provision of wheel chair training.  Guiding to improve the movements of the joints, the strengthening of muscles, coordination, balancing when sitting and when changing positions to maintain their activity of daily living.  Dressing adaptive devices and providing training to use them.  Assessing the ability to engage in the previous job or a new job in order to make the person financially independent.

“OCCUPATIONAL THERAPY IS SKILLS FOR ART OF LIVING”

 Speech & Language therapy

New Speech therapy unit was established at the end of the year 2015. The department focuses on clients in all age ranges, who are expecting the treatments for speech, language, communication, voice, fluency and swallowing related problems due to different genetic, acquired, anatomical, physiological, neurological and psychological conditions. As well as it investigates an alternative communication methods and referral process within multi disciplinary team. The clinic is running by the 03 qualified Speech and Language Therapists to the inward and out ward patients in regular basis. The clients are receiving intensive/ non intensive, direct and indirect therapy; individually or as a group, in order to improve their quality of life with effective & precious services in the holistic view point. The clinic distributes leaflets/reading materials to the clients in order to raise the community awareness, treatment provision and reduce the misconceptions, discriminations, labeling and social stigmatizations of the speech, language and communication related difficulties and disabilities. Clients have been directing to the department through the Medical officers and Consultants. In the therapy process SLTs consider about the appropriate assessment procedure, other referral processes, choice of therapy approach, intervention & management plans, probability of the possible outcomes as well as the needs of the client & the care giver. If the client is eligible to receive the therapy the intervention procedure will be plan according to the severity of the condition, age, (EBP) evidence

126

ANNUAL HEALTH BULLETIN – 2018 Special Units

based practice; considering the client’s communication need, care giver support and the distance to the hospital. Discharge criteria for the clients have been deciding again on the needs of the client & caregiver, and according to the plan of the block of therapy, results of the reassessment and the progress of the client. Clients were not giving direct discharge criteria and they will receive therapy non-intensively, if there was a possible outcome from the therapy. If the clients maintain positive outcomes, they receive therapy break and review sessions will be decided after a team discussion (MDT).

127

ANNUAL HEALTH BULLETIN – 2018 Special Units

 Nursing Care

The nursing care plays a vital part in rehabilitating disable patients. With respect to patients with spinal cord injury, bowel, bladder and skin care are the main areas of nursing care. Majority of our nursing staff were specially trained on management of spinal cord injury.

 Spinal Injury wards  Rheumatology and Medical ward  Pediatric wards  Clinics – medical/Spinal/Orthopedic/Dental/Pediatric neurology/ Dental/Autism  Health Education and Counseling  Education for special needs children  Awareness program for patients, Guardians of special needs children

Main areas of nursing care Spinal cord Injury  Skin Care – Objective is to prevent Pressure sores and maintain healthy skin  Wound care – most of the patients are transferred with pressure sores  Bowel care – As there is no proper bowel function , Nursing Officers have to teach how to empty the bowel  Nutritional support – on admission most of the patients are with

128

ANNUAL HEALTH BULLETIN – 2018 Special Units

nutritional defects  Psychological support – Due to the sudden illness many of them are with depression or any other psychological problem  Health Education(for patients, care givers and family)  Training some procedures .eg:-Self Intermittent Catheterization, Skin care

 Social Services An officer from the Central Province Social Services Department was appointed as a “Social Service Officer” to obtain aids and supply services to the needy patients. The government aids are very useful to the program of Community Resettlement and the Social Services Officer gets the main role in this program. The Rehabilitation Centre provides support by coordinating and assisting.

 Vocational Training Most of the patients are unable to engage in the original occupation following the disability. The idea behind vocational training is to enable these patients to lead a productive and independent life in the society while contributing for the development of the country. The patients are given the facility to identify, train and engage in occupations that suite their general condition and liking. e.g. making candles, cards, mats, envelopes, paper bags, pharmacy covers brooms, soaps, incense sticks and fabric painting etc.

The necessary physical and technical resources for this are provided by the Central Province Social Services Department and the Kandy Women‟s Development Centre. The Rehabilitation Centre also provides support by coordinating assistance from various well wishers.

129

ANNUAL HEALTH BULLETIN – 2018 Special Units

 Supplies of disable appliances Majority are free of charge and sometimes at a cost by a NGO.

 Counseling services by professional counselors

The importance of addressing the psychological aspect of a patient who is physically disabled cannot be overemphasized. The patients are provided with the appropriate mental health services and counseling which empower them with the inner strength to face the challenge of living with the handicap. The family of the patient will also be counseled to help create an atmosphere where the individual is capable of living an active and dignified life

 Special education unit This unit is provided education for special need children by a well trained teacher.

130

ANNUAL HEALTH BULLETIN – 2018 Special Units

 Leisure activities

New provisions have been made for leisure activities of the patients including Basket Ball, Badminton and Carom facilities.

 Training of relatives in the care of the disabled

By family meeting, family visits, allowing a bystander to be with patient and less activities need to be continued.

 Before and after assessments of Community Resettlement through field visits

Community resettlement is a crucial factor in the rehabilitation of the disabled and is yet to be addressed even at National level. However it is already underway at Digana Rehabilitation Hospital with more than 840 resettlement activities been carried out by the end of 2018. The main objective of this programme is creating a suitable environment for the patient who gets discharged from the ward. E.g. adjusting the doors to enable travelling via wheel chair by self, replacing staircases with ramps, providing easy access to toilets, installing bars to aid walking on patient‟s own. To this end, when a patient reaches the final stages of the hospital stay, an assessment is made of the patient‟s home environment. Resettlement programme also involves identifying a suitable self employment for the patient and conducting discussions with Grama Niladhari, Samurdhi officer, Social service officer and Medical officer of health to establish the patient in his home environment. Many follow up visits were conducted in 2018 to assess the success of the resettlement programme. During these visits, patients were given further instructions on how to adapt to the home environment. Readmission to the hospital and follow up clinic services were arranged as and when deemed necessary.

131

ANNUAL HEALTH BULLETIN – 2018 Special Units

 Self Care Training Centre

This centre which includes a toilet and bathroom complex enables the patients to provide themselves with self care. Thus patients, including paraplegics and wheel chair bound patients can bathe, wash cloths or shave etc. independently using the utensils attached to the modified seats.

While catering to the specific needs of rehabilitation, the hospital still maintains its Out Patient Department & clinic services (including dental clinic services) for the general population of Digana.

Additionally, the patients are transferred to Kandy and Peradeniya General Hospitals for clinic services and investigation procedures of specialized nature.

Table 8.1 Summary of basic information and services delivered at Physical Rehabilitation Center Digana

No Activity and Description 2014 2015 2016 2017 2018 01 Total No. of Admission 623 718 927 956 855 02 Discharge with total recovery 563 741 905 965 840 03 Total No. of Deaths 1 0 0 1 03 Total No. of Vocational Training 04 given 51 20 29 38 15 Total No. appliances given free of charge

 Wheelchairs 12 06 16 17 39  Crutches 05 02 02 04 16 03  Walking aides 03 02  Others – commode chairs, water mattress 04 06 18 0 02

06 No. of Patients Counseled 44 386 780 943 983 07 No. of Home Visits 10 12 11 16 13 08 General OPD average Per month 7701 7545 7298 7563 6719

The number of patients who were discharged with total recovery has increased in 2018 when compared to the previous years.

132

ANNUAL HEALTH BULLETIN – 2018 Special Units

Table 8.2 Details of Clinics held in 2018 Total Designation of Number Average First Subsequent Total Officer Clinic of attendance Visits Visits Visits conducting the Clinics per day clinic held Medical clinic 51 437 12213 12650 34.65 MO

Diabetic clinic 52 334 10627 10961 30.03 MO

Dental clinic 204 6247 6247 17.11 DS Rheumatologist Rheumatology MO clinic 137 1225 10062 11287 30.92

Pediatrician Pediatric clinic 47 149 650 799 2.18 MO

Psychiatry 12 1.59 MO Psychiatry clinic 41 541 582 Pediatric Consultant Neurology - - - Pediatric clinic Neurologist

NCD clinic 29 60 60 0.16 MOIC

OPD 80,628 80628 220.89 MO/RMO

Table 8.3 Physiotherapy, Occupational therapy & Speech therapy statistic in 2018

No of Patients Unit 2018

No of patients No of therapy units

Physiotherapy 26,554 601,240

Occupational 11508 391,380 therapy

Speech therapy 1215 2699

133

ANNUAL HEALTH BULLETIN – 2018 Special Units

The following activities were undertaken in 2018 to improve the services at Digana Rehabilitation Hospital.  Contribution from well wishers

Table 8.4 Contribution from well wishers

 Partition of speech therapy unit

Item Name Quantity Lap top 02 Wheel Chairs 21 Wheel walker 05 Tab 01 Refrigerator 01 Voice Recorder 01

134

ANNUAL HEALTH BULLETIN – 2018 Special Units

8.2 Regional Health Training Center (RHTC) – Kadugannawa Location

Regional Health Training Center (RHTC) is located by the main Kandy-Colombo trunk route at Henawala, Kadugannawa.

Introduction and History Regional Health Training Center (RHTC) Office of the Medical Officer of Health(MOH) Yatinuwara was established in 1936 to carry out preventive health activities in the area. It has been identified as a center for field training of Public Health staff since 1968. Part II training of Public Health Midwives and community nursing students were the main basic trainings conducted at the center when it was established. The Training Center was upgraded as Regional Health Training Center (RHTC) in 1990 and expanded its services as a training center to cater the needs of the provincial health department of Central Province and Ministry of health, in human resource development. Basic training of auxiliary categories and in- services trainings are carried out at RHTC at present. Medical Officer of Health (MOH) area Yatinuwara serves as the field practices area. It is located by the main Kandy-Colombo trunk route at Henawala, Kadugannawa. RHTC Comes under the Provincial Director of Health Services (PDHS), Central Province. Vision “Excellency through Training “

135

ANNUAL HEALTH BULLETIN – 2018 Special Units

Mission

“To assist in accelerating and supporting Provincial Health Department and Ministry of health where necessary in establishing and extending an integrated primary health care delivery system to serve the population in the region and to mobilize community participation in this effort”

Overall objective

To provide comprehensive intergraded quality health care services for people in Central Province.

Specific objectives

1. To address all aspects of health manpower development requirements in the region and to advice the Provincial health ministry in its policy relating to health manpower development. 2. To Initiate and undertake training programs for members of the primary health care (PHC) team according to national and provincial requirement 3. To Initiate and undertake continuing education of the PHC team. 4. To conduct research related to health services and manpower development 5. To improve and maintain the quality of care at health care institutions in the Central Province. 6. To establish proper managerial functions stewardship & health information system. 7. To establish and improve standard on knowledge and skills in private sector manpower.

136

ANNUAL HEALTH BULLETIN – 2018 Special Units

Organization Structure RHTC/MOH –Yatinuwara

DD(T)

MOH

MO AMOH (Training)

PHNT/P SPHM PHNS SDT SPHI PPO/SO MA HT

PHI PHFO EA PHM Driver Sp.Ma. Op SKS Watcher

Abbreviations DD(T) - Deputy Director (Training) PHNS - Public Health Nursing Sister

MOH - Medical Officer Of Health SPHM - Supervising Public Health Midwife AMOH - Additional Medical Officer Of Health SPHI - Supervising Public Health Inspector MO Training - Medical Officer Training SDT - School Dental Therapist PHNT- Public health Nursing Tutor MA - Management Assistant PHT-Public health Tutor PHI - Public Health Inspector

PPO - Planning & Programming Officer PHM - Public Health Midwife SO - Statistical Officer SKS - Saukya Karya Sahayaka DO- Development Officer EA - Entomological Assistant PHFO - Public Health Field Officer Sp. Ma. Op - Spry Machine Operator

Resource Personal As a prestigious Government Institute we always bound to maintain our standard in high level in academic and non-academic areas. Therefore, always our training sections are rich with well-qualified resource Personal with Postgraduate qualifications. Most of our resource persons are coming from universities and they are professionals. Examples for senior level managers in government and non-government sector and technical staff.  Professors  Charted Accountants  Consultants  Medical Doctors  SLAS officers  Medical Practitioners  Technical officers  Senior Lectures  Engineers  Researchers

137

ANNUAL HEALTH BULLETIN – 2018 Special Units

Human Resources

Our main strength is well-trained, experienced and knowledgeable staff. The team consists with qualified university graduates and Diploma holders.Their main discipline in related to education and staff training. They positioned in the institute as Medical Officer Of health, Medical Officer Training, Public health Nursing Tutor, Public health Tutor, Planning & Programming Officer, Statistical Officer,Development Officer, Entomological Assistant, Public Health Field Officer, Public health Nursing Sister, Supervising Public Health Midwife, Supervising Public Health Inspector, School Dental Therapist, Management Assistant, Public Health Inspector and Public Health Midwife.

Kindhearted supportive staff is another strong arm in the institute. They consist of drivers and SKS.

Facilities

 Lecture Halls  Auditorium 01 – Seating facilities for 100 Persons with Air Condition, Multimedia and Other Audio Visual Equipment.  Lecture Hall 2- Seating facilities for 60 Persons with Air Condition.  Lecture Hall 3- Seating facilities for 50 Persons.  Lecture Hall 4- Seating facilities for 75 Persons.  Tutorial room - Seating facilities for 30 Persons.

 Dining rooms

Dining rooms 1 – Accommodate 60 Persons

Dining rooms 1 – Accommodate 100 Persons  Hostel Facilities Accommodate facilities for 25 Persons.

 Library Facilities Accommodate facilities for 25 Readers

 Toilet and washing facilities Good condition. Clean Toilets Toilets with washing Facilities are available for males and females separately

138

ANNUAL HEALTH BULLETIN – 2018 Special Units

 Information Technology Facilities

Computer lab for 15 Persons with Internet facilities including Wi-Fi network facilities.

 Vehicles Two vans and one bus for 25 passengers with air condition available for training needs

 Other Facilities Intercom telephone system,printing facilities , Laminating & book binding

139

ANNUAL HEALTH BULLETIN – 2018 Special Units

Field Practice area Yatinuwara MOH area is equal to Divisional Secretariat area as an administrative unit. It spreads around 70 square kilo meters along the Kandy Colombo road starting 6 kilo meters away from Kandy City. There are 161 villages and 95 GramaNiladari divisions in the MOH area. Both Yatinuwara Pradeshiya Sabha (Local government) and Kadugannawa Urban council are within the Yatinuwara MOH area.

General Information of the Area

 Total Population : 113,278  Population density (Per Sq Kilometers) : 1,575  Number of GramaNiladari Divisions : 95  Number of villages : 161  Number of Public Health Midwives (PHM) Areas : 38  Number of Public Health Inspectors (PHI) Areas : 6  Number of house holdes : 26,980

140

ANNUAL HEALTH BULLETIN – 2018 Special Units

14 Field Services provided by the Medical Officer of Health and his team  Antenatal care,  Immunization,  Nutrition,  Family Planning,  Well women services,  Communicable Diseases Controlling,  Occupational Health,  Food Sanitation,  Water sanitation

 School /Per-school inspections,  Health education,  Public awareness on healthy life style,  NCD Screening,  Adolescent health,  Oral Health,  Drugs Inspection,  Mental Health,  Business registrations, Rehabilitation

Table 8.5 Programmes conducted in 2018 at RHTC Kadugannawa Name of Training/Workshop Target Group No of No of Expenditure Programmes Participan RS. t 1 Programme on Neonatal Advance MO, NO 3 78 77,895.00 Life Support 2 Programme on Presentation Skills MOO, MOHH, PHNS, 1 72 29,818.50 SPHI, SPHM, PHI, PHM 3 Short Course in Geographic MOO, MOHH, PHNS, 3 83 142,040.00 Information System (GIS) SPHI, SPHM, PHI, PHM Applications in Public Health 4 Community Health Nursing nursing officers 1 123 5,556.00 Training Programme 5 Preplacement Training Newly Recruited nursing 1 45 46,185.00 programme for newly Recruited officers nursing officers 6 Programme on Supportive RE, MOMCH, PHNS, 1 55 33,210.00 Supervision SPHM 7 Programme on Emergency PHNS, NOO, SPHI, PHI, 1 57 12,657.00 Medical Care-Basic Life Support SPHM, 8 Preplacement PHMM 1 82 83,855.00 Trainingprogramme for newly Recruited PHMM

141

ANNUAL HEALTH BULLETIN – 2018 Special Units

9 Programme on Professionalism, MOO, PHNS, PHM 1 33 9,818.00 professional ethics, Quality and safety services

10 Programme on Food Safety MOO, MOHH, SPHI 1 46 42,000.00 11 Programme on Basic Life SNT, SPHI, SPHM, PHI, 1 59 29,750.00 Support Training-Kandy PHM

12 Programme on Research SPHI, SPHM, PHI,PHM 3 38/ 56,895.00 Methodology

13 Programme on Life Style Related MO,MOH,NO,PHNS,SPHI 1 59 89,540 Disease

14 Preplacement Training MA 1 14 8,035.50 programme for newly Recruited Management Assistant

15 Induration programme for PHM PHM Trainee 1 67 9480.00 Trainees Batch 2018

16 Awareness programme on Preschool teachers and 1 63 19,660.00 Tobacco prevention for Preschool mother supportive groups teachers and mother supportive groups

17 Awareness programme on Elders 1 75 23,967.00 Tobacco prevention for elders

18 Injury Prevention and Basic First public heath staff 1 64 44,907.50 aid programme for public heath staff

19 Injury Prevention and Basic First Preschool teachers 1 33 24,100.00 aid programme for Preschool teachers 20 Promotion programme on Community 1 26 10020.00 Tobacco preventionvillages

21 NCD Prevention programme for Preschool teachers 1 34 15907.50 Preschool teachers

Total 815297.00

142

ANNUAL HEALTH BULLETIN – 2018 Special Units

Table 8.6 Basic Training Programmes conducted in 2017 / 2018 at RHTC Kadugannawa

S.No Training Programme Time Period No of Students

01 PHIBasic Training 2017/2019 18 months 42 05 PHMBasic Training 6 months 67

06 Community Health Nursing BasicTraining 2 months 321 (2018 )

Table 8.7 Selected Performance indicators in maternal and child health in the MOH area:

Indicator 201 2017 2018 6 % of Pregnant mothers registered 75 77 82 73 69 72 % of Pregnant mothers registered < 8 weeks

3.7 3 % of Teenage pregnant mothers registered 95 92 98 % of mothers tested for VDRL at the time of delivery % of Mothers Protect red for TT at the Time of 99 97 99 delivery 73 72 77 % of total deliveries reported 0 0 2 % of Home deliveries % of infants registered 68 74 74 % of eligible Families Registration 83 91 93 % of newly married couples clinic attended 13 8 19 % of mothers registered after 12 weeks 9 7.5 8 % of mothers tested for VDRL befor 12 weeks 82 85 88 % of pregnant mothers protected for rubella 99 98 99 % mothers of pregnancy outcome reported 73 97 73 No of maternal death reported 1 1 0 % of 35-year pap smear coverage 38 28 73

143

ANNUAL HEALTH BULLETIN – 2018 Special Units

8.3 Bio-Medical Engineering Services Unit

Repairing of all medical equipment was carried out by the Bio- medical Engineering Services Unit in Colombo (BES)prior to the year 2002. However, as there were 224 health institutions under the Central Provincial Health Department, it was impracticable for the BES to take care of repairs and maintenance of all the equipment in these hospitals resulting in a large number of serviceable medical equipment getting stocked in hospitals that were rendered unusable due to minor repair needs. Medical equipment requiring major repairs in secondary care hospitals were covered by the BME Unit on urgent requests. The Province did not have proper procedures for purchasing, maintenance,and condemning of medical equipment. The Central Province Bio - Medical Engineering Services unit was established in November 2002 with the aim of providing better coordinated support services within the Province to do equipment purchasing, maintenance and attends from minor repairs to major repairs of medical equipment and to maximize the equipment usage time.

Major Functions of BME Unit- Central Province

1. Repair of medical, surgical and other equipment in the provincial health institutions.

2. Services of medical, surgical and other equipment in the provincial health institutions.

3. Provision of reports on equipment and other items to be condemned.4. Provision of technical guidance on purchasing of new equipment to health institutions.

5. Provision of quality reports on newly purchased medical equipment.

6. Distribution of newly purchased equipment to health institutions.

7. Keeping inventory of medical equipment available at institutions.

8. Training health staff on maintenance of medical equipment.

The services provided by the BME Unit have gradually been improved over the years with the efforts of the dedicated team of workers being instrumental in saving millions of rupees for the healthcare system in the Central Province.

The BME unit also addresses the following with regard to purchase of new equipment for the health institutes within the province.

1 Identifying the necessary equipment and their quantity

2 Providing specifications for the required equipment

3 Provision of technical assessments

144

ANNUAL HEALTH BULLETIN – 2018 Special Units

 Provision of recommendations by comparing the goods with the pertinent specifications

 Distribution of the new equipment according to the hospital requirement and guiding the staff to handle them efficiently

 Carrying out maintenance of equipment

The BME unit has established a system of quick repair and delivery of impaired medical equipment without a back log. Documentation of equipment received and delivered is being maintained up to date. The BME unit has also taken the challenge regularly checking and servicing of major equipment and also attending to urgent repairs. Equipment which had been deemed beyond repair has been successfully repaired by the team at the Bio-Medical Engineering unit.

The BME unit continues to hold regular awareness programs on the usage and maintenance of medical equipment for hospital staff at no extra cost. This impacted improving the skills and changing the attitudes of the staff using these equipment.

During hospital visits the BME team inspects all the medical equipment used and condemned by that institute. The discarded equipment are brought back to the unit, repaired and re-distributed to other hospitals demanding them. A sticker with the information including hospital name, type of equipment and inventory number is pasted on the equipment, in order to prevent any harm to the equipment by using plasters or other sticky things, and also enables systematic identification of the items.

Establishing the BME unit with different expertise areas to handle electronic equipment, high pressure apparatus, generators, dental equipment etc. has paved an organized and efficient way of rendering services. The unit has expanded its services to handle repairing the generators and air conditioning units and also attended for the faults in electrical circuit systems to restore the power supplies.

8.4 Oral health care services in Central Province

Oral health care services in the Central Province are mainly provided by the government health institutions in the three districts Kandy, Matale and Nuwaraeliya. In addition to this private sector is also playing a contributory role to minimize oral disease burden in Central Province. Oral health care team of the Central Province consisted of OMF surgeons, Orthodontists, Restorative consultants, Regional Dental Surgeons, Dental surgeons and School Dental Therapists.

Government health institutions provide curative as well as preventive oral health care services through hospital dental clinics, Community Dental Clinics established at certain MOH offices and School Dental clinics located in major

145

ANNUAL HEALTH BULLETIN – 2018 Special Units schools in relevant districts. There are three mobile dental units one in each district to cater the oral health care need mainly of the rural and estate sector population.

Hospital dental clinics are established at Divisional, District base, General and teaching hospitals.Dental hospital Peradeniya,Teaching hospital Kandy,General hospital Nuwaraeliya, District General hospital Matale and District Base hospital Dambullaare the major government hospitals provide oral health care services to the general public. District General hospital Matale and District Base hospital Dambulla comes under the administrative control of Regional Director of Health Services, Matale.

Dental hospital Peradeniya provides many disciplines of oral health care services to the patients who are living in the province and island wide. Teaching hospital Kandy is also providing specialized care in the disciplines of Oro-Maxillo-Facial (OMF) surgery, Orthodontics and Restorative Dentistry to the patient living in those areas. Specialised clinics established at SirimavoBandaranayake memorial Children‟s hospital, Peradeniya also provide orthodontic services to the children under 14 years of age. General hospital Nuwaraeliyaand District General hospital Mataleare also equipped with a well established Oro-maxillo –facial units rendering the services to the public.

Preventive oral health programme are mainly conducted through Regional dental surgeons in relevant districts. Theseprogrammesinclude oral cancer prevention programmes, preschool and school teacher training programmes, school children education sessions, maternal and child oral health promotions and oral health promotion for government officers. Most ofthese programmes are supported by the field health care staff Public health Midwives and Public Health Inspectors under the supervision of Regional Dental surgeon and with the help of Community Dental surgeons.

Oral cancer prevalence is high among estate workers and rural population of the Central province due to the habit of betel quid chewing and smoking. Hence special emphasis was paid for the oral cancer prevention programmes and health education programmes for estate health workers, mobile oral cancer screening programmes at estate levels and display of health education materials were carried out.

It has been identified that prevention of oral diseases should be done through life cycle approach starting from pre pregnancy period. Therefore oral health promotion for pregnant mothers was well incorporated into the preventive programmes specially at the MOH level. At the same time most of the preschool children screened and preventive and curative measures were taken while educating and encouraging the parents and preschool teachers to maintain tooth friendly environment at preschools and home. Preschool teacher training programmes were organized at MOH level and “health promotion preschool concept” was introduced to them. The prevalence of dental caries is high among school children hence special national preventive programmes such as “Save

146

ANNUAL HEALTH BULLETIN – 2018 Special Units molar program” were conducted in the central province to prevent dental caries among school children.

Though there is declining trend in oral disease burden in the Central province due to the comprehensive curative, preventive and promotive oral health care provision network, still the oral disease burden in the rural and estate population is escalating. Dental caries and periodontal diseases are common problem among young children. Oral cancer is a major health problem in the province specially among the estate sector. Therefore it is essential to strengthen the oral health promotive programmes while upgrading the curative dental care services to cater the needy people.

8.4.1 Mobile Dental Service

The mobile dental service was established in 2002 to provide satisfactory curative and preventive dental care for the people living in rural and estate areas where accessibility to dental clinic is minimal. These areas recognized as very difficult areas due to difficult geographical terrain. Poor infrastructure facilities and low socioeconomic and education levels have led to high incidence of dental caries and periodontal diseases among this underserved people. Mobile units were established to address these issues and these units offer the services of oral disease screening, diagnosing, referring and providing simple treatment procedures to the needy in the province.

Table 8.8 Dental services in Central Province 2018

Kandy Matale Nuwaraeliya Total

Hospital Dental Clinics 45 14 23 82 Community Dental Clinics 03 01 0 04 Adolescent Dental Clinics 04 02 01 07 School Dental Clinics 32 12 10 54 School dental clinics functioning 31 08 08 47 Mobile Dental Unit 01 01 02 04

147

ANNUAL HEALTH BULLETIN – 2018 Special Units

Table 8.9 Performance of Dental Surgeons in 2018

Kandy Matale Nuwaraeliya Total

Emergency Care

Extractions 45540 32254 30242 108036 Oro - facial pain relief 24492 10440 15070 50002 Dento - alveolar trauma 449 193 642

Soft tissue injuries 448 192 640

Post Op infections / bleeding 416 1596 170 2182 Routine Care TF 28621 19454 10659 58734 Amalgam 2856 1016 3872

GIC 41326 12598 18231 72155 Composite 7807 3103 2285 13195 RCT (Dressings) 1529 908 2437 RCT (Completions) 995 436 1431 Pulp Therapy 3504 2901 1367 7772 Scaling 10855 5480 5208 21543 Fluoride applications 898 577 1475 Fissure Sealants 480 538 1018 OPMD 173 195 354 722 Minor Oral Surgery 825 1293 2118 HE Sessions 4299 1589 2796 8684 Referrals 3520 3419 1794 8733 Others 16460 6123 9449 32032 Total attendance 187013 65219 72243 324475 Pregnant Mothers 10469 8222 7457 26148 Age under 3 1477 2462 2089 6028 Adolescents (13 - 19) 13566 6956 6789 27311 Inward patients 626 454 1080

148

ANNUAL HEALTH BULLETIN – 2018 Special Units

Table 8.10 Performance of School Dental Therapists in 2018

Matale Nuwaraeliya

Permanent filling : Deciduous 14629 17526

: Permanent 1973 2498

Dressing : Deciduous + Permanent 3269 4389

Complete Scaling 2762 3390

Miscellaneous 2628 3619

Referrals 1810 352

Casual 9490 3275

Total attendances 35758 47223

Health education : No of Children 24641 38785

: No of Adults 4081 11666

: No of Teachers 868 2775

: No of Sessions 862 151

No of outreach programme 311 34943

Table 8.11 Mobile dental unit performances in 2018

Kandy Matale Nuwaraeliya No of patients 5562 screened 5600 21736 No of patients 5562 treated 4300 12780

149

ANNUAL HEALTH BULLETIN – 2018 Special Units

8.5 Mental Health Services in the Central Province

Mental Health Services in the Central Province include:

1. Mental Health Promotion and Prevention in the Community

2. Mental Health care coordinated at District and Provincial levels

The services being implemented in the Central Province have been identified as a model for Mental Health for other Provinces in Sri Lanka.

This was mainly achieved by Central province Mental Health management teams. This team consists of Provincial Director of Health Services, Consultant Psychiatrists, Consultant Community Physician, , Regional Directors, Medical officers from District mental Health Resource centers, Medical officers in the special mental health units, Social service department officers & Probation Officers.

Community mental health activities supported through the MOMH

Strength of the central province‟s Mental Health programme lies on the already established primary health care structure where the MOMH is the key person. MOMHs in the province were trained in the annual 4 day Mental Health Training programme held for Medical Officers.

PHM‟s role is crucial in improving the quality of community care of psychiatric patients. Their motivation is to be increased by enlisting the support of the field staff of the AGA office of the relevant MOH area. This is being coordinated by the Community Mental Health Resource Centre of the district, supported by the district and provincial management levels.

The well established system of collection of statistics based on the regular sending of mental health returns by (PHM and PHNS) MOH and peripheral clinics to the relevant Focal point of the district is vital for evaluating the progress of the Community Mental Health Programme.

Psychiatry care services in tertiary care institutions in Central Province

Teaching hospital Kandy

The Psychiatric Department at TH Kandy has 60 beds and two consultant units. Generally, bed occupancy in wards is more than 100% at any given time with a high turnover of patients throughout the year. The average stay of a patient ranges from 1 to 2 weeks.

At Kandy, there is a day center, where day care is provided for patients six days a week. Every Friday a part time counselor from the National Youth Council provides counseling service while every Wednesday a voluntary counseling 150

ANNUAL HEALTH BULLETIN – 2018 Special Units service is provided by final year psychology special degree students from University of Peradeniya. Hospital base counselor of women in need (WIN) is available in Kandy mental health unit. Psychiatric social work is provided by 02 PSWs. They do home visits, help patients to sort out social problems and also organize annual Sinhala/Tamil New Year celebrations and consumer society. The unit liaises with the Social Service Department to obtain self employment allowance, housing allowance etc. for patients. Family meetings and music therapy programs are also organized by PSWs once a month. School children in the Kandy area, in rotation take part in these music programs in the psychiatric wards.

The Department at Kandy holds a Sinhala/ Tamil New Year celebrations annually in a ground outside the hospital. While being a popular annual event amongst patients, their family members and the staff, it has also being subjected to wide media coverage.

Another specialized service provided by this Department is forensic Psychiatric service with a large number of persons being referred from the courts for forensic psychiatric reports.

Psychiatric Department Kandy and Peradeniya are accredited units for postgraduate training in MD Psychiatry, Diploma in psychiatry and Kandy Hospital under takes Psychiatric Training for general MD, Diploma in Family Medicine & MSc in Clinical Psychology.

TH Kandy Consultant psychiatrist from teaching hospital Kandy regularly visits both DeltotaSisila Rehabilitation Centre and DH Walapane Rehabilitation centre .

Teaching hospital Peradeniya

Teaching Hospital, Peradeniya (THP) has a male unit (32 beds), a female unit (35 beds) and a Neuro Psychiatry Unit (10 beds). The head of the Department of Psychiatry, Faculty of Medicine, University of Peradeniya also heads the Peradeniya Hospital Psychiatry Unit. They have five Consultant Psychiatrist.

THP also has an active 6 days a week Day Centre where two Occupational Therapists are based. One Social Worker is supported by two Mental Development Officers who are trained in social work. There are Day Centre based social skills training programmes, alcohol anonymous type Saturday morning Alcohol Programme and The Nursing Officer in Charge of the Clinic has a special interest in the area of slow learners and runs a very successful parental group with the advocacy of the Psychiatrist running the Clinic. The respective clinic also trains the members of the NGO „Women‟s Development Centre‟.

The Unit works in coordination with the Social Services Department, National Child Protection Authority and some other Governmental and Non Governmental Organizations in Mental Health. (e.g. Nivahana, Provincial Ministry of Health, Central Province)

151

ANNUAL HEALTH BULLETIN – 2018 Special Units

Teaching Hospital, Peradeniya, too is participating in District Meetings, Central Province Management Meetings, System Group Meetings with regard to the administrative issues in Mental Health.

THP gives supervision and support to Mampitiya Alcohol Rehabilitation Centre. Together with Teaching Hospital, Kandy, THP also provides support to Deltota Rehabilitation Centre.

SirimawoBandaranayake Specialist hospital Peradeniya

A child psychiatry clinic conducted by consultant psychiatrist from teaching hospital Kandy is recently established at SBSCH Peradeniya. It is conducted on every Friday and has seen over 1700 per year.

Being the only specialist children hospital having a child psychiatry clinic is and immense service to the area.

Table 8.12 Mental health staff – Kandy / Matale / Nuweraeliya districts

Kandy Matale Nuwaraeliya Health staff 38 13 31 School teachers 32 12 09 School children 39 00 36 Volunteers 03 00 00 World Mental Health day 01 00 00 Autism Day 01 00 00 World Mental Health day 05 00 02 Work places 06 00 35 Youth Camp 00 00 36 Army Camp 00 00 03 Preschool teachers 00 09 00 Special School 02 00 00 Elderly Program 06 00 00 Consumers and care takers group 08 07 Other Staff (AG Office Police) 12 00 00

Meetings 05 00 00

Total 76 42 79

152

ANNUAL HEALTH BULLETIN – 2018 Special Units

Mental Health Care Service Centers in Central Province

Community mental health resource centre -Katugastota

This Centre is situated in DH Katugastota and serves to educate Government &Non Government Organizations, the community at large and identified special personnel on Mental Health. The Centre has conducted Educational programmes

There is an improvement in the number of training programmes conducted by the Centre when compared to the previous year.Additionally, the World Mental Health Day celebrated by organizing a exhibition and educational programme to mark the day.

District General hospital Nawalapitiya

The Mental health unit of the DGH/Nawalapitiya has been functioning since the year 2000. It provides psychiatry clinic care and day centre facilities for the population of the Nawalapitiya area as well as for some areas of the surrounding NuwaraEliya district. The mental health unit was headed by a Consultant Psychiatrist. The facilities included a male and female ward, clinic room and a day Centre room.

Teaching hospitalGampola

Gampola mental health services are headed by consultant psychiatrist. It has daily clinic services ,daycentre facilities and out reach clinics .Namely DH Pussellawa, DH Panvilatenna and DH Kurunduwatta.

Sisila rehabilitation hospital Deltota

Sisila Rehabilitation Hospital was established in 1995 at Deltota. Here Rehabilitation based around structured day involving everyday activities such as sweeping and cooking religious activities personal care activities out door work such as agriculture or caring for the cow and indoor works such as making rugs or pharmacy bags.

Alcohol rehabilitaioncentreMampitiya

Alcohol Rehabilitation Unit at Mampitiya was the first government institute, which provided rehabilitation facilities for alchoholic patients. It is administered under direct supervision of the Psychiatry Unit of the Peradeniya Teaching Hospital. Though located in the Central Province, it provided services for persons from any region of the country.

Medical Officers in psychiatry are conducting clinics in following institution under the supervision of Consultant Psychiatrist .DGH Nawalapitiya, TH Gampola, DBH Theldeniya, DH Galagedara, Mampitiya Rehabilitation Hospital, DH Katugastota. In addition to community awareness programmes

153

ANNUAL HEALTH BULLETIN – 2018 Special Units they are conducting out reachclincs in following hospitals namely DH Ududumbara ,Digana Rehabilitation Hospital, DH Akurana, DH Wattegama, MOH Office Hatharaliyadda, DH Kurunduwatta, DH Pussellawa and DH Panvilatenna.

Functioning Mental Health Clinics in Kandy District

1. Teaching Hospital Kandy

2. Teaching Hospital Peradeniya

3. SirimawoBandaranayeke Specialist Children Hospital Peradeniya

4. DGH Nawalapitiya

5. DBH Theldeniya

6. DH Akurana

7. DH Bokkawala

8. Rehabilitation Centre Delthota

9. DH Galadedrea

10. DH Panvilatenna

11. DH Pussellewa

12. DH Thalatuoya

13. DH Ududumbara

14. DH Wattegama

15. DH Yakgahapitiya

16. DH Sangarajapura

17. DH Kuruduwatta

18. Rehabilitation Centre Mampitiya

19. DH Muruthalawa

20. DH Madolkele

154

ANNUAL HEALTH BULLETIN – 2018 Special Units

21. TGH Gampola

22. DH Katugastota

23. DH Kadugannawa

24.Rehabilitation Hospital Digana

Functioning Mental Health Clinics in NuweraEliyaDistrict

1. Bace Hospital N eliya 2. DBH Rikillagaskada 3. DBH Dikoya 4. DH Walapane – Rehabilitation Centre 5. DH Maldeniya - Rehabilitation Centre 6. DH Kothmale 7. DH UdaPussallawa 8. DH Kotagala 9. DH Agarapatana 10. DH Lindula 11. DH Maskeliya 12. DH Bagawantalawa 13. DH Ginigathhena 14. DH Watawela 15. DH Madulla 16. DH Teripaha

Functioning Mental Health Clinics in Matale District DGH Matale DBH Dambulla DH Laliambe – Rehabilitation Centre DH Muwamdeniya DHNalanda DH Sigiriya DH Rattota

155

ANNUAL HEALTH BULLETIN – 2018 Special Units

DH Yatawatta DH Galewela DH Kongahawela DH Wilgamuw

8.13 Diagnosed new cases by type of disease in 2018

ICD 10 Kandy Matale Nuwaraeliya

Code F00- 03 Dementia 158 83 44 F05 Delirium 15 05 05 F06 Other mental health disorders due to brain 06 36 damage 17 F10 Substance Abuse 403 225 325 F20 Schizophrenia 247 529 222 F22 Delusional Disorder 85 25 54 F23 Acute and Transient Psychotic disorders 107 12 43 F25 Schizoaffective Disorder 26 23 35 F31 Bipolar affective Disorder 388 437 382 F32,F33 Depressive disorder 2084 827 827 F40,F41 Anxiety Disorders 154 143 320 F42 Obsessive Compulsive Disorder 106 15 05 F43F9A Adjustment disorders and Bereavement 102 32 26 F44 Dissociative Disorder 63 04 00 F45 Somatoform Disorders 26 05 33 F50 Eating disorders 05 07 00 F52 Sexual Disorder 35 12 04 F71-73 Mental Retardation 140 80 146 F80 Speech and language disorder 03 01 76 F84 Autisms and other PDD 76 00 33 F90 ADHD 246 35 42 F91 Conduct Disorder 45 04 09 F93 Emotional disorders with onset specific to 01 04 childhood 51 F95 Tic disorder 00 03 00 60 Epilepsy 138 60 50 365 Deliberate self harm 365 291 61 Other (specify) 274 61 352 3157 Total 5844 3157 2112

156

ANNUAL HEALTH BULLETIN – 2018 Special Units

Table 8.14 Human Resource Development in 2018

Kandy Matale Nuwaraeliya 01 Consultant Psychiatrists 11 02 01 02 MO Psychiatry 02 00 00 03 MO MH 01 05 04 04 Community Psychiatry Nurse 04 00 09 05 OT 04 01 03 06 PSW 07 00 03 07 Development Assistant-Mental 05 00 00 Health

157

ANNUAL HEALTH BULLETIN – 2018 Estate Health Development

9. Estate Health Development

Estate population is generally identified as the vulnerable population in the country with poor health indices. Central Province has 18.9% of estate population. Governments‟ several policy decisions, has changed this scenario. Presently most of the indicators have marked improvement such as the Infant Mortality Rate, Maternal Mortality Rate etc,. Nutrition indicators in the estate sector are also improving based on the 2016/17 DHS survey.

A cabinet decision was taken in 2007 to provide equitable preventive health services to the estate sector similar to the rural and urban sectors under the Provincial health authority. This decision made the Medical officer of Health responsible for the health of the total population including the estate sector. As most of the Public Health Midwives in the estate sector were absorbed to the Government sector, MOH gain the ability to conduct all field ante-natal clinics in the estate sector. Outreach well women clinics services were extended to all MOH areas by the public health staff. Special outreach clinics have been conducted by the VOG from DGH Nuwaraeliya and DBH Dickoya selected hospitals in the Nuwaraeliya district. District Base hospital Dickoya has been developed with the financial support (1200Mn) of the Indian government. Currently the new hospital complex is providing a wide area of services to a vast majority of the estate population in the Nuwaraeliya district.

Table 9.1 Statistics of Estate population in the Central Province

Districts Male Female Total %

Kandy 40467 45150 85617 17.6

Matale 8970 10109 19079 3.9

Nuwaraeliya 182318 198262 380580 78.4

Total 2,31,755 7,53,521 4,85,276 18.9

A cabinet approval was given in the year 2009 to take over the estate hospitals to the Provincial Health authority also given path to integrate the curative services in the estate sector with the State health system. Under this eight hospitals in the Nuwaraeliya district, two hospitals in Kandy district and one hospital from Matale district were taken over and developed under the Estate Health Development project of Ministry of Health.

158

ANNUAL HEALTH BULLETIN – 2018 Estate Health Development

Table 9.2 List of Estate hospitals taken over to State Health system

Districts Name of hospital

Nuwaraeliya DH Gonapitiya

DH Diagama

DH Agrapathana

DH Highforest

DH North Medakumbura

DH Mulloya

PMCU Ragala

PMCU Frotof

Kandy DH Westhall

DH Madulkelle

Matale DH Bandarapola

According to recent proposal of the Estate and Urban Health unit of the Ministry of Health, plans have been submitted for the rest of the health institutions currently under the management of plantation companies for the nationalization of the Estate Health and awaiting cabinet approval.

Asian Development Bank (ADB) has also extended its support to the Province for the upliftment of the vulnerable population, especially the plantation sector through a health system enhancement project. This is a 5 year project commencing from 23rd October 2018. For this 45 primary health care hospitals and 3 secondary hospitals were identified for development. Since these hospitals were chosen based on vulnerability index most of these hospitals are adjoining to some estate areas.

Health department is working closely with the estate management and with the PHDT and other International and local NGOs to improve the health of the estate population. Ministry of Health has collaborated with the Save the Children International in the „Good nutrition in the tea estates‟ project (2015 to2018) to improve the nutritional status of the estate population, where the Central Provincial health department is extending its support through the team of the Medical Officer of Health in the selected estates under their Regional Director of Health services‟ guidance.

159

ANNUAL HEALTH BULLETIN – 2018 Financial Management system

10. Financial Management system

Financial Management system mainly comprised of two categories as recurrent and capital. Recurrent management system mainly involves in maintaining the existing health system and capital financial management involves in activities related to development of the health system. Total allocation (both capital and recurrent) for the province is indicated below.

Table 10.1 Total financial allocation to the central province 2017 2018

Recurrent allocation 6,752,370,250.00 7,727,743,928.00

Capital allocation 1,042,053,919.00 1,041,960,593.00

Fig 10.1 Total allocation (both capital and recurrent) for the Province 2007-2018

9,000,000,000

8,000,000,000

7,000,000,000

6,000,000,000 Recurrent 5,000,000,000 allocation

4,000,000,000 Capital allocation 3,000,000,000

2,000,000,000

1,000,000,000

160

ANNUAL HEALTH BULLETIN – 2018 Financial Management system

10.1 Recurrent Expenditure Summary - 2018

10.1.1 General Administration & Establishment Services

Table 10.2 General administration in 2018 (561-1-4-0)

Total Object Title Total Estimate Balance Rs. Expenditure

1001 salaries and wages 134,088,468 134,088,468.00 - 1002 overtime and holiday pay 49,029,052 49,029,052.00 - 1003 other allowances 73,076,529 73,076,529.00 - traveling expenses 1101 domestic 14,812,718 14,812,718.00 - stationery and office 1201 requisites 8,992,021 8,992,021.00 - 1202 fuel and lubricants 22,462,155 22,462,155.00 -

1203 diet and uniforms 166,603 166,602.00 1.00 1205 other supplies 3,202,598 3,202,598.00 - 1301 vehicles 25,214,554 25,214,554.00 - plant machinery and 1302 equipment 1,372,827.00 1,372,827.00 - 1303 building and structures 1,724,271 1,724,271.00 - postal and 1402 telecommunication 5,259,563.00 5,259,563.00 - 1403 electricity and water 3,156,854 3,156,854.00 - 1404 rent rates and local taxes 1,731,802 1,731,802.00 - 1409 other 7,356,377 7,356,377.00 - 1506 property loan interest 1,797,831 1,797,830.00 1.00 contingency services (if 1702 applicable) 3,640,763 3,640,763.00 - implementation of the 1703 official language policy (if applicable) 602,567 602,567.00 - Total 357,687,553 357,687,551.00 2.00

161

ANNUAL HEALTH BULLETIN – 2018 Financial Management system

10.1.2 Patient Care Services (Curative care services)

Table 10.3 Patient Care Services in 2018 (561-71-5-0)

Total Total Object Title Balance Rs. Estimate Expenditure

1001 Salaries and wages 2,146,492,466 2,146,492,465 1.24

1002 Overtime and holiday pay 1,926,000,000 1,926,000,000 -

1003 Other allowances 1,262,439,121 1,262,439,121 0.17 Traveling expenses 1101 domestic 25,541,964 25,541,964 (0.03) Stationery and office 1201 requisites 10,441,469 10,441,469 0.32

1202 Fuel and lubricants 44,189,718 44,189,719 (0.53)

1203 Diet and uniforms 88,471,470 88,471,470 0.43

1204 Medical supplies 28,559,839 28,559,839 (0.37)

1205 Other supplies 28,600,026 28,600,026 0.30

1301 Vehicles 30,150,449 30,150,449 (0.39) Plant machinery and 1302 equipment 7,504,757 7,504,757 (0.16)

1303 Building and structures 9,933,631 9,933,631 0.31

1401 Transport 223,165 223,165 - Postal and 1402 telecommunication 19,292,193 19,292,193 0.23

1403 Electricity and water 118,288,189 118,288,189 (0.22)

1404 Rent rates and local taxes 4,543,438 4,543,438 0.38

1409 Other 145,628,758 145,628,759 (0.53)

1506 Property loan interest 30,461,350 30,461,349 0.79 Contingency services (if 1702 applicable) 1,957,509 1,957,509 0.47 Implementation of the 1703 official language policy (if applicable) 1,005,284 1,005,284 0.25

5,929,724,796 5,929,724,793 2.66

162

ANNUAL HEALTH BULLETIN – 2018 Financial Management system

10.1.3 Community Health Services (Preventive Care Services)

Table 10.4 Community Health Services in 2018 (561-72-6-0)

Total Object Title Total Estimate Balance Rs. Expenditure

1001 Salaries and wages 702,433,315 702,433,315 0.02

1002 Overtime and holiday pay 230,746,570 230,746,569 1.00

1003 Other allowances 368,927,083 368,927,083 -

1101 Traveling expenses domestic 78,668,645 78,668,645 - Stationery and office 1201 3,521,232 3,521,232 requisites -

1202 Fuel and lubricants 15,044,650 15,044,650 0.27 1203 Diet and uniforms 935 935 - 1204 Medical supplies 47,625 47,625 - 1205 Other supplies 3,783,166 3,783,166 -

1301 Vehicles 11,696,788 11,696,788 0.41 Plant machinery and 1302 411,211 411,210 equipment 0.79 1303 Building and structures 2,028,998 2,028,998 - 1401 Transport 32,773 32,773 0.07 Postal and 1402 5,974,189 5,974,189 telecommunication - 1403 Electricity and water 6,264,276 6,264,276 - 1404 Rent rates and local taxes 224,392 224,392 0.47 1409 Other 926,761 926,761 0.31 1506 Property loan interest 9,204,746 9,204,746 0.08 Contingency services (if 1702 297,489 297,489 applicable) 0.05 Implementation of the 1703 official language policy (if 96,735 96,735 applicable) -

1,440,331,579 1,440,331,576 3.47

163

ANNUAL HEALTH BULLETIN – 2018 Financial Management system

10.1.4 Summary of Recurrent Health Expenditure by Programmes

Table 10.5 Summary of Recurrent health expenditure by programmes

Programme Expenditure/Rs. General 357,687,551.00 Administration

Patient care services 5,929,724,793.00

Community Health services 1,440,331,576.00

Total 7,727,743,920.00

Fig 10.2 Total Expenditure observed (both capital and recurrent) during year 2007-2018

9,000,000,000

8,000,000,000

7,000,000,000

6,000,000,000

5,000,000,000 Recurrent 4,000,000,000 expenditure

3,000,000,000 Capital expenditure 2,000,000,000

1,000,000,000

10.2 Development Projects Different fund sources provided capital expenditure for the development of health sector in the Central Province during year 2015. Provincial Specific Development Grants (PSDG) and Health sector development project (HSDP) made the biggest contributions for those development activities. The other sources included, Estate health program, Dengue control program, Kidney diseases prevention program, Dog sterilization program, Primary health development project, NCD prevention program, UNICEF, District Nutrition Action Plan (DNAP) and Mental Health program.

164

ANNUAL HEALTH BULLETIN – 2018 Financial Management system

Table 10.6 Distribution of expenditure by Category of Development Projects in 2018

Financial Source of fund Allocation / Rs Expenditure progress %

Provincial Specific Development Grants 275,000,000.00 178,774,549.75 65.01 Health sector development project 592,889,921.00 330,499,132.84 55.74 Primary health development project 13,638,801.00 6,638,800.85 48.68 Non communicable diseases programme 7,974,290.00 7,421,826.05 93.07 Dengue control programme 21,159,500.00 6,809,660.00 32.18 Estate health programme 4,673,056.00 4,673,056.00 100.00 UNICEF 245,600.00 199,600.00 81.27 Dog sterilization programme 6,215,088.00 6,215,088.00 100.00 District Nutrition Action Plan 3,492,200.00 3,242,277.00 92.84 Prevention of Chronic Kidney diseases 55,689,052.00 24,374,678.69 43.77 Development of Base hospital Dickoya 1,632,105.00 1,632,104.14 100.00 Strengthening of Laboratory services 17,566,829.00 17,566,829.00 100.00 Development of mental health 16,859,432.00 5,216,272.61 100.00 Criteria Based Grants 970,000.00 730,552.34 75.31 National programme for Tuberculosis control & Chest diseases 36,000.00 23,512.00 65.31 Purchasing of Bio medical equipment 20,546,573.00 20,546,573.00 100.00 Improvement of eIMMR system 282,146.00 282,146.00 100.00 Health sanitation programme 3,090,000.00 2,970,000.00 96.12 Total 1,041,960,593.00 617,816,658.27 60.41

165

ANNUAL HEALTH BULLETIN – 2018 Financial Management system

10.2.1 Provincial Specific Development Grants (PSDG)

Table 10.7 Financial Progress of activities performed under PSDG project by Districts in 2018

PDHS Kandy Matale N’Eliya Total Office Approved Amount 14.273 96.240 86.987 77.500 275.000 (Rs mn) Expenditure (Rs 8.354 65.574 58.232 46.614 178.774 mn) Progress (%) 58.53 68.14 66.94 60.15 65.01

Table 10.8 Physical Progress of activities performed under PSDG project by Districts in 2018

PDHS Office Kandy Matale N’Eliya

No.of No.of No. of. No.of. Completed Completed Completed Completed Projects Projects Projects Projects

11 11 34 22 44 38 16 11

10.2.2 Second Health Sector Development Project (SHSDP)

Table 10.9 Financial Progress of activities performed under HSDP project by Districts in 2018

Kandy Matale Nuwara eliya Approved Amount (Rs mn) 190.70 114.52 119.55

Expenditure (Rs mn) 81.01 19.55 42.35

Progress % 42.60 17.10 35.40

166

Annexures

Annexure 1. Information of Divisional hospitals in Kandy District 2018

Admission

No Deliveries of Total no Total no of Beds

No Admission of

Total no Total no of Wards

No Clinics Held of

No of ETU No Patients ETU of

No of Inpatient No Days Inpatient of

Bed OccupancyBed Rate

Institution

No of Lab No Tests DoneLab of

No of Transferred Out No Transferred of

No OPD Attendance of

No of Clinic No Attendance Clinic of

No of Admission per No day Admission per of

No of Deaths within 48 No Hours Deaths within of

No of Deaths after 48 No hours Deaths of after 48 of No of OPD Attendance per No day OPD Attendance per of 1 Ankumbura 6 63 4702 13 6526 28.38 846 2 11 63755 175 270 17802 155 31 4685 2 Pussallawa 5 71 3691 10 5636 21.75 546 12 5 76506 210 2001 22513 174 60 203 3 Dolosbage 3 35 947 3 2841 22.24 218 0 0 20725 57 58 5760 145 13 0 4 Deltota 5 62 3829 10 6118 27.03 880 11 0 61585 169 0 14248 97 42 0 5 Madolkele 5 81 4830 13 10541 35.65 2053 19 1 52727 144 1742 10497 96 71 0 6 Galagedara 5 67 5526 15 8271 33.82 816 9 0 77993 214 1612 26765 277 11 2700 7 Udadumbara 5 82 3190 9 5747 19.20 964 4 4 59260 162 73 17232 129 46 6989 8 Menikhinna 7 76 4078 11 5973 21.53 718 14 2 67190 184 5 27615 268 5 0 9 Akurana 6 81 5055 14 5321 18.00 737 2 0 79642 218 859 35583 207 61 5275 10 Kadugannawa 5 68 3077 8 7450 30.02 666 3 2 69407 190 3041 25535 331 1 7701 11 Mampitiya 4 50 1981 5 6001 32.88 181 1 1 39491 108 583 13697 393 0 0 11960 12 Katugastota 6 54 6016 16 8313 42.18 1053 12 0 328 1738 32981 235 13 9052 6 13 Wattegama 5 52 4262 12 6085 32.06 734 12 2 58436 160 1631 19415 180 6 9373 14 Sangarajapura 3 30 1686 5 2432 22.21 172 1 4 31009 85 660 8267 261 0 0 15 Medawala 5 40 2783 8 5002 34.26 324 0 0 49440 135 608 11868 184 1 0 16 Minipe 4 35 1577 4 2553 19.98 286 1 1 28384 78 346 7379 183 0 425 17 Marassana 5 46 2790 8 3821 22.76 113 5 0 55534 152 772 11976 123 0 0 18 Panwilatanna 2 30 2059 6 3576 32.66 283 6 1 35982 99 8 9856 208 2 96 19 Hasalaka 4 39 1727 5 2153 15.12 367 4 1 60832 167 193 9380 51 4 0 20 Tittapajjala 4 47 5185 14 6235 36.35 583 10 48 86300 236 2909 20828 144 6 0 21 Jambugahapitiya 3 23 1445 4 1582 18.84 251 0 0 30013 82 0 11485 310 0 0 22 Wattappola 3 26 1186 3 1777 18.72 74 2 0 24516 67 176 7597 128 1 44 23 Kotaligoda 4 36 7373 20 10020 76.26 783 2 0 38561 106 4107 15227 364 1 821 24 Pamunuwa 3 34 1303 4 2256 18.18 239 2 0 23599 65 95 11333 283 0 1060

- 167 -

Annexures

day

Hours

per per day

No Deliveries of

Total no Total no of Beds

No Admission of

Institution

Total no Total no of Wards

No Clinics Held of

No of ETU No Patients ETU of

hours hours of Admission

No of Admission per No Admission per of

No of Inpatient No Days Inpatient of

Bed OccupancyBed Rate

No of Deaths after 48 No Deaths after 48 of

No of Lab No Tests DoneLab of

No of Transferred Out No Transferred of

No OPD Attendance of No OPD Attendance of

No of Deaths within 48 No Deaths within of No of Clinic No Attendance Clinic of 25 Gelioya 2 24 1256 3 1874 21.39 34 0 0 37036 101 89 8640 187 0 0 26 Bambaradeniya 4 34 4265 12 5144 41.45 445 1 0 43874 120 167 9226 124 0 0 27 Hataraliyadda 4 45 5153 14 11700 71.23 436 9 3 54492 149 1789 15871 168 12 0 28 Talathuoya 3 30 3797 10 6189 56.52 795 6 3 60394 165 314 17773 102 0 1810 29 Uduwela 3 27 1861 5 2260 22.93 313 0 0 9080 25 0 1179 33 0 0 30 Galaha 3 35 1266 3 2489 19.48 263 8 0 19139 52 29 6411 87 5 0 31 Yakgahapitiya 3 28 1802 5 2969 29.05 137 5 2 57230 157 636 15909 210 0 0 32 Narampanawa 3 30 156 0 184 1.68 4 1 1 25105 69 7 5036 77 0 0 33 Galpihilla 3 19 1897 5 2905 41.89 182 2 0 27303 75 60 6043 72 1 0 34 Kuruduwatta 4 39 3147 9 5493 38.59 586 4 2 85701 235 563 21067 263 0 0 35 Kahawatta 2 9 96 0 1143 34.79 4 0 0 24705 68 6 5933 97 0 120 36 Udagama Atabage 2 23 6 0 6 0.07 0 0 0 16828 46 0 5263 18 0 0 37 Morahena 2 14 232 1 312 6.11 64 0 0 8902 24 0 3763 119 0 0 38 Batumulla 3 25 159 0 275 3.01 43 0 0 10126 28 0 3555 99 0 0 39 Medamahanuwara 4 30 2529 7 4794 43.78 307 0 0 24016 66 111 8268 124 7 865 40 Ambagahapallessa 4 34 901 2 1323 10.66 440 0 0 32462 89 102 6624 118 0 0 41 Kolongoda 5 43 1703 5 3839 24.46 858 0 0 26439 72 334 5829 138 9 0 42 Bokkawala 5 44 3576 10 4616 28.74 1052 4 2 60068 165 1138 18514 132 0 0 43 Dunhinna 3 12 707 2 996 22.74 39 0 0 18500 51 325 4844 139 0 0 44 Westhall 2 7 415 1 804 31.47 191 0 0 20766 57 0 3045 112 0 0 45 Ulapane 2 12 1157 3 2884 65.84 48 0 0 18779 51 31 7806 97 0 1367 46 Murutalawa 2 18 1839 5 2632 40.06 275 1 0 18578 51 257 10777 180 0 0 47 Pattiyagama-Pallegama 2 12 444 1 780 17.81 100 2 0 22493 62 76 2870 56 0 0 48 Prison Hospital -Bogambara 2 15 649 2 5991 109.42 71 0 0 42194 116 0 2023 145 0 3185 49 Prison Hospital - Pallekele 1 10 126 0 841 23.04 14 0 0 6633 18 0 1124 93 0 1502 20813

Total 180 1847 119437 327 198673 29.47 20588 177 96 36 5702 29521 592232 7916 409 57273

- 168 -

Annexures

Annexure 2. Information of Divisional hospitals in Matale District 2018

Out

Day

Days

Done

Hours

Per Per Day

Admissions

Attendance Attendance Attendance

Average Clinic

Total no OPD Total no of

Total no Total no of Beds

Total Total no. of ETU

Total no Total no of Clinic

Total no Total no of Wards

Institution

Total no of Total Deathsno of

Attendance Attendance Per Day

Total no Total no of Tests Lab

Total no of Inpatient Total Inpatient no of

Total no DeliveriesTotal no of

Total no Total no of Admission

No of Deaths within 48 No Deaths within of

Average Per Admission

Total no Total no of Transferred

Total no. of Clinics Held Total no. of Clinics

Bed OccupancyBed (%) Rate Average OPD Average Attendance 1 Galewela 5 81 33.06 9773 7198 20 1952 22 22 77546 212 638 34553 95 22312 27 6811 2 Gammaduwa 2 4 4.86 71 71 0 0 0 0 9547 26 64 2732 7 0 0 0 3 17 28.86 1791 1417 4 187 5 5 21518 59 96 4713 13 0 27 648 3 Hadungamuwa 4 Hattota amuna 3 13 74.60 3540 2099 6 433 0 0 28295 78 152 11548 32 1845 1 3 5 Hettipola 5 45 55.43 9104 7269 20 490 3 7 57670 158 362 19686 54 56163 14 3109 6 Illukkumbura 4 7 14.32 366 306 1 40 0 0 7384 20 147 3594 10 0 0 108 12.99 3 51 10 7 Kongahawela 4 58 2749 1207 148 2 2 18597 154 3656 0 0 77 Laggala 5 62 7.11 1608 1428 4 276 0 0 30676 84 242 8082 22 840 3 338 8 /pallegama 9 Laliambe 2 13 9.86 468 31 0 0 0 0 22927 63 115 3842 11 0 0 0 10 Lenadora 2 12 24.77 1085 574 2 47 0 0 43271 119 262 12079 33 1628 0 29 11 Madipola 4 43 57.75 9064 6439 18 512 8 8 63006 173 465 19404 53 0 5 1220 12 Maraka 2 10 9.45 345 335 1 28 0 0 23036 63 111 4176 11 0 0 236 13 Muwandeniya 2 18 82.95 5450 101 0 6 0 0 12377 34 152 4725 13 0 0 0 14 Nalanda 4 40 29.21 4264 2924 8 507 5 8 53025 145 610 19433 53 37534 6 1709 15 Ovilkanda 3 11 26.80 1076 1051 3 240 0 0 18995 52 160 6543 18 1137 0 0 16 Rattota 4 57 32.10 6679 4299 12 662 3 3 81539 223 626 30400 83 15019 4 1020 17 Sigiriya 4 41 21.86 3272 2896 8 365 4 5 29587 81 319 12117 33 224 0 1048 18 Yatawatte 4 41 26.27 3931 2193 6 72 3 3 44296 121 166 18376 50 9261 3 142 Total 62 573 30.90 64636 41838 115 5965 55 63 643292 1762 4841 219659 602 145963 90 16498

- 169 -

Annexures Annexure 3. Information of Divisional hospitals in Nuwaraeliya District 2018 Total No of Total Total Average Average Total Total Total Average Number Bed Patients Total Total No Total Total No of Total Number No of No Of No Of Number Numb No. of No of of Occupa No Of Of clinic No Of Institutions Patients No Of of OPD OPD clinic Lab of er of Admissi Admissi Inpatie ncy Treated Clinic Attendan Deliveri Tarnsferr Death Attenda Attenda Attendan Tests Wards Beds ons ons nts Rate in the Held ce es ed out nce nce ce Done Days ETU Agarapathana 4 46 2846 8 3376 20.39 500 43 46953 129 631 163 10784 66 5346 110 Bogawanthalawa 4 63 2248 6 4457 19.65 503 5 31930 87 626 89 8900 100 0 17 Dayagama 3 26 964 3 2715 29.01 276 2 20236 55 0 103 4062 39 0 15

Ginigathhena 4 65 1494 4 2396 10.24 439 21 34763 95 169 132 8712 66 0 5

Gonaganthanna 4 22 7499 21 2724 34.39 754 5 35546 97 5110 423 13844 33 1206 10 Gonapitiya 3 18 313 1 353 5.45 140 3 9819 27 0 73 2615 36 0 1 Haguranketha 3 23 3660 10 3376 40.77 242 6 56745 155 2098 168 18085 108 1109 0 High forest 3 24 1199 3 1474 17.06 563 7 33683 92 79 70 8101 116 0 8

Kotagala 5 62 3826 10 6618 29.65 946 15 61147 168 326 138 20947 152 0 64

Kothmale 4 50 4307 12 6876 38.20 875 5 41196 113 2556 489 20597 42 1033 9 Laxapana 3 22 7121 20 2040 25.76 166 6 29780 82 0 39 2777 71 0 2 Lindula 6 78 2714 7 4834 17.22 1333 20 44333 121 2583 165 8298 50 1184 55 Madulla 2 21 2198 6 2001 26.47 298 5 31003 85 929 131 8401 64 0 0 Maldeniya 5 79 1318 4 5282 18.57 266 9 14485 40 614 106 4772 45 0 4 Mandaramnuwara 2 8 450 1 921 31.98 92 0 13367 37 203 60 2691 45 0 1 Maskeliya 6 122 2113 6 5132 11.68 518 9 18569 51 1705 150 8158 54 1794 30 Mathurata 5 56 3531 10 5508 27.32 220 2 32612 89 2598 329 12748 39 0 2 Mooloya 4 23 2102 6 1259 15.21 98 7 23401 64 1393 101 5186 51 0 0 Nildandahinna 5 24 792 2 303 3.51 218 5 22983 63 291 117 4697 40 83 13 North Madakumbura 3 18 138 0 122 1.88 38 0 11053 30 0 121 2803 23 408 2 Theripeha 2 10 257 1 191 5.31 34 0 14330 39 3 125 3712 30 0 0 Udapussallawa 7 78 3159 9 3471 12.36 624 6 36538 100 1154 213 9723 46 1935 21 Walapane 6 101 5469 15 12629 34.73 1411 3 50538 138 2402 6526 21956 3 19141 19 Watawala 5 53 11197 31 4104 21.51 638- 170 - 0 37571 103 985 75 11758 157 0 31 Total 98 1092 70915 194 82162 11192 184 752581 2062 26455 10106 224327 22 33239 419 Annexures Annexure 4. Information of Primary Medical Care Units in Central Province 2018 KANDY MATALE NUWARAELIYA Average Average Average Average Total Average Average Total Total Total Total Total no of Total no of no of Total no of Number no of Total no of no of no of no of no of No Of OPD no of Clinic OPD no of Clinic of OPD No Of Clinic Institute OPD Clinic Institute OPD Clinic Institutions clinic Attenda Clinics Attenda Attenda Clinics Attenda OPD Attenda Clinic Attenda Attenda Attenda Attenda Attenda Attenda nce per Held nce per nce per Held nce per Attenda nce per Held nce per nce nce nce nce nce day clinic day clinic nce day clinic 1 Dedunupitiya 5727 16 712 46 15 Aluthwewa 3164 9 815 33 25 Ambewela 6494 18 48 1376 29 2 Kotikambe 8076 22 3223 130 24 Aluvihare 13719 38 4490 50 90 Hangarapitiya 13309 36 39 2322 60 3 Girihagama 10792 30 975 31 31 Dewahuwa 11676 32 1983 19 104 Hapugasthalawa 13867 38 53 4602 87 4 Sandasiridunuwila 2612 7 358 16 22 Dullewa 5170 14 2672 129 21 Hatton 37282 102 351 9708 28 5 Makuldeniya 7931 22 1578 29 54 Elkaduwa 2370 6 753 31 24 Kandapola 21900 60 108 5414 50 6 Dodamwela 10910 30 1242 13 96 Gurubabila 1459 4 228 6 38 Kalaganwatte 6203 17 27 569 21 7 Balana 7300 20 1852 25 74 Kalundewa 3627 10 784 16 49 Katambulawa 9606 26 58 2134 37 8 Yahalatanna 5688 16 762 43 18 Kandenuwara 3814 10 1626 19 86 Keerthibandarapura 8944 25 79 1988 25 9 Mailapitiya 11804 32 529 17 31 Madawala-ulpata 7064 19 1830 38 48 Kurupanawala 8010 22 133 2640 20 10 Udatalawinna 27504 75 1434 21 68 Opalgala 1326 4 307 9 34 Manakola 14412 39 52 3566 69 11 Elamaldeniya 18100 50 996 13 77 Paldeniya 1438 4 499 14 36 Maswela 15546 43 124 3862 31 12 Rajawella 23756 65 619 22 28 Pallepola 8174 22 3734 120 31 Munwatte 12432 34 44 5156 117 13 Suduhumpola 29645 81 1122 26 43 Ukuwela 7467 20 4839 66 73 Nanuoya 19706 54 46 1953 42 14 Mawathura 6982 19 726 18 40 Wahakotte 2465 7 288 13 22 Nawathispane 10795 30 84 3026 36 15 Kurugoda 11655 32 1650 60 27 Wawalawawa 3450 9 380 6 63 Protof 5620 15 41 5973 146 16 Rambukewela 7133 20 282 10 28 Pundaluoya 16139 44 169 9693 57 17 Alawathugoda 19208 53 564 2 282 Ragala 23190 64 76 5617 74 18 Gohagoda 22159 61 1943 19 102 Rupaha 13383 37 111 4590 41 19 Mahakanda 19472 53 593 118 5 Upkot 2814 8 42 2801 67 20 Galhinna 8141 22 1032 31 33 Widulipura 7173 20 70 2539 36 21 Welamboda 12392 34 1783 31 58 Wijebahukanda 13652 37 93 2736 29 22 Rrambuke-ela 4283 12 68 3 23 23 Godahena 13063 36 611 27 23 24 Poojapitiya 12300 34 273 10 27 25 Mapakanda 11139 31 693 12 58 26 Kalugamuwa 14571 40 561 22 26 27 Meemure 1261 3 357 29 12 28 Madawala Bazzar 6600 18 1265 22 58 29 Chest Clinic Kandy 84498 232 30 Rehabilitation Hos.Digana80633 221 42844 571 75 31 SISILA Deltota 915 24 38 - 171 - Total 505335 1384 71562 1441 50 Total 76383 209 25228 569 44 Sub Total 280477 768 1848 82265 45